Candidal thrombophlebitis of central veins: case report and review.

Although candidemia and central catheter septic thrombosis is quite common, central veins thrombophlebitis caused by Candida spp. is a rarely reported complication in critically ill patients. Here we report a case of thrombophlebitis of the right internal jugular and subclavian veins due to Candida albicans which occurred in a patient admitted in the intensive care unit for major trauma. The individual was eventually cured after prolonged course of antifungal therapy. We also review 24 additional cases of Candida induced central veins thrombophlebitis reported since 1978. A central vein catheter was in place in all 25 patients with 21 (84%) being admitted in an intensive care unit, 22 (88%) were receiving total parenteral nutrition and 23 (92%) undergoing a course of antibiotic therapy. Overall mortality was 16%, including two patients who received no therapy and died. In the group of patients receiving only medical therapy, the mortality rate was 13%, while no deaths were observed among those treated with combined medical and surgical therapy. Literature data suggest that Candida caused central veins thrombophlebitis is a rare and probably underdiagnosed infectious complication of the critically ill patient. Despite the dramatic presentation with persistent candidemia, mortality is low even with a conservative medical approach with prolonged fungicidal therapy through the use of amphotericin B or echinocandins. Thus, the decision for a combined surgical debridement should be assessed for each patient.

Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients: A 1-year, large, prospective surveillance study in 5 Italian hospitals.

BACKGROUND: Bloodstream infections (BSIs) from multidrug-resistant (MDR) bacteria cause morbidity and mortality in intensive care unit (ICU) patients worldwide. This study investigated the incidence of BSIs in 5 adult general ICUs in Rome, Italy, and evaluated the mortality rate and risk factors associated with these infections. METHODS: Over a 12-month period, 1,318 patients were enrolled. Demographic characteristics, Simplified Acute Physiology Score II (SAPS II), comorbidities, and BSI isolate data were collected. After stratification for the outcome, statistical analysis was performed to assess the impact of patient risk factors on in-hospital mortality. RESULTS: There were 324 BSIs in 175 patients recorded, with an in-hospital mortality rate of 46%. Univariate analysis revealed that SAPS II, cardiac comorbidity, and Klebsiella pneumoniae BSI were significantly associated with a higher risk of death. Having a K pneumoniae BSI and cardiac illness at admission were both confirmed to be associated with death by multivariate analysis (P = .0162 and P = .0158, respectively). Most of the K pneumoniae isolates showed high resistance rates to carbapenems. CONCLUSION: BSIs caused by K pneumoniae and cardiovascular comorbidity in ICU patients are associated with a higher risk of death. Thorough surveillance for MDR pathogens and stratification of the patients' risk on admission into the ICU are key to improving the outcomes of these infections.

Endocarditis caused by nutritionally variant streptococci: a case report and literature review.

Infective endocarditis (IE) due to Abiotrophia and Granulicatella species, previously referred to as nutritionally variant streptococci (NVS), occurs rarely and is often associated with negative blood cultures. Rates of treatment failure, infection relapse and mortality are higher than those of endocarditis caused by other viridans streptococci. We report a case of endocarditis caused by Granulicatella adiacens in a young man with no risk factors, who was successfully treated with surgery and combination antimicrobial chemotherapy, and provide a literature review of endocarditis attributable to these rare species of fastidious gram-positive cocci which have proven exceedingly difficult to treat, with high rates of relapse and therapeutic failure despite in vitro effective antibiotic treatment regimens. Analysis of literature revealed a high prevalence (61%) of valvular heart predisposing conditions associated with endocarditis caused by NVS, such as congenital valvular heart disease or heart valve prosthesis. On the other hand, 39% of cases showed no evidence of risk factors. Combination antimicrobial chemotherapy with penicillin and gentamicin represents the antimicrobial treatment of choice in the management of patients with IE attributable to NVS. Heart valve replacement surgery should be considered in cases of hemodynamic derangement due to significant valve destruction.