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Extra-cardiac endovascular infections in the critically ill

  • Kerina J. Denny
  • Anand Kumar
  • Jean-Francois Timsit
  • Kevin B. LauplandEmail author
Narrative Review
Part of the following topical collections:
  1. Severe infections in the critically ill

Abstract

Vascular infections are associated with high complication rates and mortality. While there is an extensive body of literature surrounding cardiac infections including endocarditis, this is less so the case for other endovascular infections. The objective of this narrative review is to summarize the epidemiology, clinical features, and selected management of severe vascular infections exclusive of those involving the heart. Endovascular infections may involve either the arterial or venous vasculature and may arise in native vessels or secondary to implanted devices. Management is complex and requires multi-disciplinary involvement from the outset. Infective arteritis or device-related arterial infection involves removal of the infected tissue or device. In cases where complete excision is not possible, prolonged courses of antimicrobials are required. Serious infections associated with the venous system include septic thrombophlebitis of the internal jugular and other deep veins, and intracranial/venous sinuses. Source control is of paramount importance in these cases with adjunctive antimicrobial therapy. The role of anticoagulation is controversial although recommended in the absence of contraindications. An improved understanding of the management of these infections, and thus improved patient outcomes, requires multi-center, international collaboration.

Keyword

Arteritis Mycotic aneurysm Thrombophlebitis Endovascular 

Notes

Compliance with ethical standards

Conflicts of interest

None of the authors has conflicts of interest to disclose.

References

  1. 1.
    Holland TL, Baddour LM, Bayer AS, Hoen B, Miro JM, Fowler VG Jr (2016) Infective endocarditis. Nat Rev Dis Primers 2:16059PubMedPubMedCentralGoogle Scholar
  2. 2.
    Deipolyi AR, Czaplicki CD, Oklu R (2018) Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther 8:S61–S70PubMedPubMedCentralGoogle Scholar
  3. 3.
    Lopes RJ, Almeida J, Dias PJ, Pinho P, Maciel MJ (2009) Infectious thoracic aortitis: a literature review. Clin Cardiol 32:488–490PubMedPubMedCentralGoogle Scholar
  4. 4.
    Bansal RC, Ashmeik K, Razzouk AJ (2001) An unusual case of vegetative aortitis diagnosed by transesophageal echocardiography. J Am Soc Echocardiogr 14:237–239PubMedGoogle Scholar
  5. 5.
    Frank MW, Mehlman DJ, Tsai F, Lomasney JW, Joob AW (1999) Syphilitic aortitis. Circulation 100:1582–1583PubMedGoogle Scholar
  6. 6.
    Osler W (1885) The gulstonian lectures, on malignant endocarditis. Br Med J 1:467–470PubMedPubMedCentralGoogle Scholar
  7. 7.
    Wilson WR, Bower TC, Creager MA, Amin-Hanjani S, O’Gara PT, Lockhart PB, Darouiche RO, Ramlawi B, Derdeyn CP, Bolger AF, Levison ME, Taubert KA, Baltimore RS, Baddour LM, American Heart Association Committee on Rheumatic Fever E, Kawasaki Disease of the Council on Cardiovascular Disease in the Y, Council on C, Stroke N, Council on Cardiovascular R, Intervention, Council on Cardiovascular S, Anesthesia, Council on Peripheral Vascular D, Stroke C (2016) Vascular graft infections, mycotic aneurysms, and endovascular infections: a scientific statement from the American heart association. Circulation 134:e412–e460PubMedGoogle Scholar
  8. 8.
    Gornik HL, Creager MA (2008) Aortitis. Circulation 117:3039–3051PubMedPubMedCentralGoogle Scholar
  9. 9.
    Foote EA, Postier RG, Greenfield RA, Bronze MS (2005) Infectious aortitis. Curr Treat Options Cardiovasc Med 7:89–97PubMedGoogle Scholar
  10. 10.
    Macedo TA, Stanson AW, Oderich GS, Johnson CM, Panneton JM, Tie ML (2004) Infected aortic aneurysms: imaging findings. Radiology 231:250–257PubMedGoogle Scholar
  11. 11.
    Sorelius K, Budtz-Lilly J, Mani K, Wanhainen A (2019) Systematic review of the management of mycotic aortic aneurysms. Eur J Vasc Endovasc Surg 58:426–435PubMedGoogle Scholar
  12. 12.
    Lin CH, Hsu RB (2014) Primary infected aortic aneurysm: clinical presentation, pathogen, and outcome. Acta Cardiol Sin 30:514–521PubMedPubMedCentralGoogle Scholar
  13. 13.
    Huang YK, Chen CL, Lu MS, Tsai FC, Lin PL, Wu CH, Chiu CH (2014) Clinical, microbiologic, and outcome analysis of mycotic aortic aneurysm: the role of endovascular repair. Surg Infect (Larchmt) 15:290–298Google Scholar
  14. 14.
    Lee CH, Hsieh HC, Ko PJ, Chou AH, Yu SY (2014) Treatment of infected abdominal aortic aneurysm caused by Salmonella. Ann Vasc Surg 28:217–226PubMedGoogle Scholar
  15. 15.
    Sorelius K, Mani K, Bjorck M, Sedivy P, Wahlgren CM, Taylor P, Clough RE, Lyons O, Thompson M, Brownrigg J, Ivancev K, Davis M, Jenkins MP, Jaffer U, Bown M, Rancic Z, Mayer D, Brunkwall J, Gawenda M, Kolbel T, Jean-Baptiste E, Moll F, Berger P, Liapis CD, Moulakakis KG, Langenskiold M, Roos H, Larzon T, Pirouzram A, Wanhainen A, European MAAc (2014) Endovascular treatment of mycotic aortic aneurysms: a European multicenter study. Circulation 130:2136–2142PubMedGoogle Scholar
  16. 16.
    Lau C, Gaudino M, de Biasi AR, Munjal M, Girardi LN (2015) Outcomes of open repair of mycotic descending thoracic and thoracoabdominal aortic aneurysms. Ann Thorac Surg 100:1712–1717PubMedGoogle Scholar
  17. 17.
    Muller BT, Wegener OR, Grabitz K, Pillny M, Thomas L, Sandmann W (2001) Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: experience with anatomic and extra-anatomic repair in 33 cases. J Vasc Surg 33:106–113PubMedGoogle Scholar
  18. 18.
    Salzler GG, Long B, Avgerinos ED, Chaer RA, Leers S, Hager E, Makaroun MS, Eslami MH (2018) Contemporary results of surgical management of peripheral mycotic aneurysms. Ann Vasc Surg 53:86–91PubMedGoogle Scholar
  19. 19.
    Gonzalez I, Sarria C, Lopez J, Vilacosta I, San Roman A, Olmos C, Saez C, Revilla A, Hernandez M, Caniego JL, Fernandez C (2014) Symptomatic peripheral mycotic aneurysms due to infective endocarditis: a contemporary profile. Medicine (Baltimore) 93:42–52Google Scholar
  20. 20.
    Alawieh A, Chaudry MI, Turner RD, Turk AS, Spiotta AM (2018) Infectious intracranial aneurysms: a systematic review of epidemiology, management, and outcomes. J Neurointerv Surg 10:708–716PubMedGoogle Scholar
  21. 21.
    Zanaty M, Chalouhi N, Starke RM, Tjoumakaris S, Gonzalez LF, Hasan D, Rosenwasser R, Jabbour P (2013) Endovascular treatment of cerebral mycotic aneurysm: a review of the literature and single center experience. Biomed Res Int 2013:151643PubMedPubMedCentralGoogle Scholar
  22. 22.
    Ohtake M, Tateishi K, Ikegaya N, Iwata J, Yamanaka S, Murata H (2017) Initial treatment strategy for intracranial mycotic aneurysms: 2 case reports and literature review. World Neurosurg 106:1051PubMedGoogle Scholar
  23. 23.
    Kume Y, Fukushima S, Shimahara Y, Matsumoto Y, Yamashita K, Kawamoto N, Kobayashi J (2018) Intracranial mycotic aneurysm is associated with cerebral bleeding post-valve surgery for infective endocarditis. Interact Cardiovasc Thorac Surg 27:635–641PubMedGoogle Scholar
  24. 24.
    Morris NA, Matiello M, Lyons JL, Samuels MA (2014) Neurologic complications in infective endocarditis: identification, management, and impact on cardiac surgery. Neurohospitalist 4:213–222PubMedPubMedCentralGoogle Scholar
  25. 25.
    Gross BA, Puri AS (2013) Endovascular treatment of infectious intracranial aneurysms. Neurosurg Rev 36:11–19PubMedGoogle Scholar
  26. 26.
    Eidt JF, Habibipour S, Saucedo JF, McKee J, Southern F, Barone GW, Talley JD, Moursi M (1999) Surgical complications from hemostatic puncture closure devices. Am J Surg 178:511–516PubMedGoogle Scholar
  27. 27.
    Antonello RM, D’Oria M, Cavallaro M, Dore F, Cova MA, Ricciardi MC, Comar M, Campisciano G, Lepidi S, De Martino RR, Chiarandini S, Luzzati R, Di Bella S (2019) Management of abdominal aortic prosthetic graft and endograft infections. A multidisciplinary update. J Infect Chemother 25:669–680PubMedGoogle Scholar
  28. 28.
    Kilic A, Arnaoutakis DJ, Reifsnyder T, Black JH 3rd, Abularrage CJ, Perler BA, Lum YW (2016) Management of infected vascular grafts. Vasc Med 21:53–60PubMedGoogle Scholar
  29. 29.
    Gharamti A, Kanafani ZA (2018) Vascular graft infections: an update. Infect Dis Clin N Am 32:789–809Google Scholar
  30. 30.
    Lyons OT, Baguneid M, Barwick TD, Bell RE, Foster N, Homer-Vanniasinkam S, Hopkins S, Hussain A, Katsanos K, Modarai B, Sandoe JA, Thomas S, Price NM (2016) Diagnosis of aortic graft infection: a case definition by the management of aortic graft infection collaboration (MAGIC). Eur J Vasc Endovasc Surg 52:758–763PubMedGoogle Scholar
  31. 31.
    Li HL, Chan YC, Cheng SW (2018) Current evidence on management of aortic stent-graft infection: a systematic review and meta-analysis. Ann Vasc Surg 51:306–313PubMedGoogle Scholar
  32. 32.
    FitzGerald SF, Kelly C, Humphreys H (2005) Diagnosis and treatment of prosthetic aortic graft infections: confusion and inconsistency in the absence of evidence or consensus. J Antimicrob Chemother 56:996–999PubMedGoogle Scholar
  33. 33.
    Beloin C, Fernandez-Hidalgo N, Lebeaux D (2017) Understanding biofilm formation in intravascular device-related infections. Intensive Care Med 43:443–446PubMedGoogle Scholar
  34. 34.
    Flemming HC, Wingender J, Szewzyk U, Steinberg P, Rice SA, Kjelleberg S (2016) Biofilms: an emergent form of bacterial life. Nat Rev Microbiol 14:563–575Google Scholar
  35. 35.
    Timsit JF, Rupp M, Bouza E, Chopra V, Karpanen T, Laupland K, Lisboa T, Mermel L, Mimoz O, Parienti JJ, Poulakou G, Souweine B, Zingg W (2018) A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill. Intensive Care Med 44:742–759PubMedGoogle Scholar
  36. 36.
    Hasse B, Husmann L, Zinkernagel A, Weber R, Lachat M, Mayer D (2013) Vascular graft infections. Swiss Med Wkly 143:w13754PubMedGoogle Scholar
  37. 37.
    Ciofu O, Rojo-Molinero E, Macia MD, Oliver A (2017) Antibiotic treatment of biofilm infections. APMIS 125:304–319PubMedGoogle Scholar
  38. 38.
    Mejer N, Westh H, Schonheyder HC, Jensen AG, Larsen AR, Skov R, Benfield T (2014) Increased risk of venous thromboembolism within the first year after Staphylococcus aureus bacteraemia: a nationwide observational matched cohort study. J Intern Med 275:387–397PubMedGoogle Scholar
  39. 39.
    Wilson Dib R, Chaftari AM, Hachem RY, Yuan Y, Dandachi D, Raad II (2018) Catheter-related staphylococcus aureus bacteremia and septic thrombosis: the role of anticoagulation therapy and duration of intravenous antibiotic therapy. Open Forum Infect Dis 5:ofy249PubMedPubMedCentralGoogle Scholar
  40. 40.
    Chirinos JA, Garcia J, Alcaide ML, Toledo G, Baracco GJ, Lichtstein DM (2006) Septic thrombophlebitis: diagnosis and management. Am J Cardiovasc Drugs 6:9–14PubMedGoogle Scholar
  41. 41.
    Laupland KB (2007) Vascular and parameningeal infections of the head and neck. Infect Dis Clin N Am 21:577–590Google Scholar
  42. 42.
    Riordan T (2007) Human infection with Fusobacterium necrophorum (Necrobacillosis), with a focus on Lemierre’s syndrome. Clin Microbiol Rev 20:622–659PubMedPubMedCentralGoogle Scholar
  43. 43.
    Hagelskjaer LH, Prag J, Malczynski J, Kristensen JH (1998) Incidence and clinical epidemiology of necrobacillosis, including Lemierre’s syndrome, in Denmark 1990–1995. Eur J Clin Microbiol Infect Dis 17:561–565PubMedGoogle Scholar
  44. 44.
    Huang TT, Liu TC, Chen PR, Tseng FY, Yeh TH, Chen YS (2004) Deep neck infection: analysis of 185 cases. Head Neck 26:854–860PubMedGoogle Scholar
  45. 45.
    Osowicki J, Kapur S, Phuong LK, Dobson S (2017) The long shadow of lemierre’s syndrome. J Infect 74(Suppl 1):S47–S53PubMedGoogle Scholar
  46. 46.
    Stauffer C, Josiah AF, Fortes M, Menaker J, Cole JW (2013) Lemierre syndrome secondary to community-acquired methicillin-resistant Staphylococcus aureus infection associated with cavernous sinus thromboses. J Emerg Med 44:e177–e182PubMedGoogle Scholar
  47. 47.
    Johannesen KM, Bodtger U (2016) Lemierre’s syndrome: current perspectives on diagnosis and management. Infect Drug Resist 9:221–227PubMedPubMedCentralGoogle Scholar
  48. 48.
    Cupit-Link MC, Nageswara Rao A, Warad DM, Rodriguez V (2017) Lemierre syndrome: a retrospective study of the role of anticoagulation and thrombosis outcomes. Acta Haematol 137:59–65PubMedGoogle Scholar
  49. 49.
    Campo F, Fusconi M, Ciotti M, Diso D, Greco A, Cattaneo CG, de Vincentiis M (2019) Antibiotic and anticoagulation therapy in Lemierre’s syndrome: case report and review. J Chemother 31:42–48PubMedGoogle Scholar
  50. 50.
    Garcia J, Aboujaoude R, Apuzzio J, Alvarez JR (2006) Septic pelvic thrombophlebitis: diagnosis and management. Infect Dis Obstet Gynecol 2006:15614PubMedPubMedCentralGoogle Scholar
  51. 51.
    Twickler DM, Setiawan AT, Evans RS, Erdman WA, Stettler RW, Brown CE, Cunningham FG (1997) Imaging of puerperal septic thrombophlebitis: prospective comparison of MR imaging, CT, and sonography. AJR Am J Roentgenol 169:1039–1043PubMedGoogle Scholar
  52. 52.
    Choudhry AJ, Baghdadi YM, Amr MA, Alzghari MJ, Jenkins DH, Zielinski MD (2016) Pylephlebitis: a review of 95 cases. J Gastrointest Surg 20:656–661PubMedGoogle Scholar
  53. 53.
    Wong K, Weisman DS, Patrice KA (2013) Pylephlebitis: a rare complication of an intra-abdominal infection. J Community Hosp Intern Med Perspect 3:20732Google Scholar
  54. 54.
    Falagas ME, Vardakas KZ, Athanasiou S (2007) Intravenous heparin in combination with antibiotics for the treatment of deep vein septic thrombophlebitis: a systematic review. Eur J Pharmacol 557:93–98PubMedGoogle Scholar
  55. 55.
    Kanellopoulou T, Alexopoulou A, Theodossiades G, Koskinas J, Archimandritis AJ (2010) Pylephlebitis: an overview of non-cirrhotic cases and factors related to outcome. Scand J Infect Dis 42:804–811PubMedGoogle Scholar
  56. 56.
    Brown CE, Stettler RW, Twickler D, Cunningham FG (1999) Puerperal septic pelvic thrombophlebitis: incidence and response to heparin therapy. Am J Obstet Gynecol 181:143–148PubMedGoogle Scholar
  57. 57.
    Pradka SP, Trankiem CT, Ricotta JJ (2012) Pylephlebitis and acute mesenteric ischemia in a young man with inherited thrombophilia and suspected foodborne illness. J Vasc Surg 55:1769–1772PubMedGoogle Scholar
  58. 58.
    Tamaki I, Kami K, Yamamoto E, Morimoto T (2014) Catheter-directed thrombolysis through the operatively recanalized umbilical vein for acute extensive portal vein thrombosis: report of a case. Clin J Gastroenterol 7:376–380PubMedGoogle Scholar
  59. 59.
    Akhrass FA, Abdallah L, Berger S, Sartawi R (2015) Gastrointestinal variant of Lemierre’s syndrome complicating ruptured appendicitis. IDCases 2:72–76PubMedPubMedCentralGoogle Scholar
  60. 60.
    Sherigar R, Amir KA, Bobba RK, Arsura EL, Srinivas N (2005) Abdominal pain secondary to pylephlebitis: an uncommon disease of the portal venous system, treated with local thrombolytic therapy. Dig Dis Sci 50:983–987PubMedGoogle Scholar
  61. 61.
    Gelber AC, Schachna L, Mitchell L, Schwartzman G, Hartnell G, Geschwind JF (2001) Behcet’s disease complicated by pylephlebitis and hepatic abscesses. Clin Exp Rheumatol 19:S59–S61PubMedGoogle Scholar
  62. 62.
    Khatri IA, Wasay M (2016) Septic cerebral venous sinus thrombosis. J Neurol Sci 362:221–227PubMedGoogle Scholar
  63. 63.
    Ebright JR, Pace MT, Niazi AF (2001) Septic thrombosis of the cavernous sinuses. Arch Intern Med 161:2671–2676PubMedGoogle Scholar
  64. 64.
    Bhatia K, Jones NS (2002) Septic cavernous sinus thrombosis secondary to sinusitis: are anticoagulants indicated? A review of the literature. J Laryngol Otol 116:667–676PubMedGoogle Scholar
  65. 65.
    Andes DR, Urban AW, Acher CW, Maki DG (1998) Septic thrombosis of the basilic, axillary, and subclavian veins caused by a peripherally inserted central venous catheter. Am J Med 105:446–450PubMedGoogle Scholar
  66. 66.
    Erdem Y, Akpolat T, Oymak O, Colakoglu M, Yasavul U, Turgan C, Caglar S (1995) Magnetic resonance imaging diagnosis of right atrial septic thrombus caused by subclavian catheter in a hemodialysis patient. Nephron 69:174–175PubMedGoogle Scholar
  67. 67.
    Denny KJ, Cotta MO, Parker SL, Roberts JA, Lipman J (2016) The use and risks of antibiotics in critically ill patients. Expert Opin Drug Saf 15:667–678PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Intensive CareGold Coast University HospitalGold CoastAustralia
  2. 2.Burns, Trauma and Critical Care Research CentreUniversity of QueenslandHerstonAustralia
  3. 3.Sections of Critical Care Medicine and Infectious Diseases, Health Sciences Centre, Department of MedicineUniversity of ManitobaWinnipegCanada
  4. 4.AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2)ParisFrance
  5. 5.University of Paris, IAME, INSERMParisFrance
  6. 6.Department of Intensive Care ServicesRoyal Brisbane and Women’s HospitalBrisbaneAustralia
  7. 7.Queensland University of TechnologyBrisbaneAustralia

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