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Persistent methicillin-resistant Staphylococcus aureus bacteremia from an infected superior vena cava thrombus

Ryaan El-Andari1, Jayan Nagendran1, Mohammed Al Aklabi2

  • 1Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, T6G 2B7, Canada.

Future Cardiology
|March 28, 2023
PubMed

Insights

Infection in end-stage renal disease patients is deadly. A rare calcified superior vena cava thrombus caused refractory bacteremia, necessitating surgical removal for life-saving source control.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Cardiovascular Surgery

Background:

  • End-stage renal disease (ESRD) patients face high mortality, with infections being a primary cause.
  • Hemodialysis catheter placement is a frequent source of infection, leading to complications like venous thrombosis, bacteremia, and thromboembolism.
  • Calcification of venous thrombi is uncommon, but infected thrombi, particularly in the superior vena cava, pose severe risks including septicemia and embolic events.

Observation:

  • A 46-year-old patient presented with a calcified superior vena cava thrombus.
  • The patient experienced bacteremia that was resistant to antibiotic treatment.
  • This condition necessitated aggressive surgical intervention.

Findings:

  • Surgical removal of the infected, calcified superior vena cava thrombus was successfully performed under circulatory arrest.
  • This intervention achieved infectious source control.
  • The procedure aimed to prevent further septicemic and embolic complications.

Implications:

  • This case highlights a rare but critical complication of hemodialysis access in ESRD patients.
  • Aggressive surgical management, including circulatory arrest, can be life-saving for refractory infections associated with large venous thrombi.
  • Effective management of infected venous thrombi is crucial for improving outcomes in high-risk patient populations.
Keywords:
hemodialysispersistent bacteremiasuperior vena cava thrombosis

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