Suppurative thrombophlebitis refers to venous thrombosis associated with inflammation in the setting of bacteremia . Histologic findings consist of inflammation and suppuration within the vein wall. Thrombus with or without pus may be seen within the vein lumen, with evidence of perivascular inflammation.
Suppurative thrombophlebitis should be suspected in patients with persistent bacteremia after 72 hours of appropriate antimicrobial therapy, particularly in the setting of an intravascular catheter. The diagnosis may be made based on culture data together with radiographic evidence of thrombosis. The principles of treatment for suppurative thrombophlebitis include removing the focus of infection (eg, intravenous catheter), prompt administration of intravenous antibiotics, and consideration regarding surgical intervention and/or anticoagulation.
The pathogenesis, clinical manifestations, microbiology, diagnosis, and treatment of suppurative thrombophlebitis of peripheral and jugular veins and the superior and inferior vena cava will be reviewed here. Issues related to portal vein pylephlebitis, septic dural thrombosis, and septic pelvic thrombophlebitis are discussed separately. (See "Pylephlebitis" and "Septic dural sinus thrombosis" and "Septic pelvic thrombophlebitis".)
Pathogenesis — Peripheral vein suppurative thrombophlebitis occurs most frequently in the setting of an intravenous catheter or peripherally inserted central venous catheter (PICC) . Most cases of intravenous catheter sepsis are not complicated by suppurative thrombophlebitis; in one series including 102 episodes, suppurative thrombophlebitis was observed in 7 percent of cases .
The incidence of peripheral vein suppurative thrombophlebitis is highest in patients with specific risk factors such as burns , steroids , and injection drug use . Burn patients may be at particular risk due to several factors including high skin inoculum of organisms, hyperalimentation, use of broad spectrum antibiotics, and impairment of local defense due to loss of skin integrity .