Clinical characteristics of septic pulmonary embolism in adults: A systematic review

• Published in: Respiratory medicine 2014-01, Vol.108 (1), p.1-8
• Main Authors: Ye, Rui, Zhao, Li, Wang, Cuihong, Wu, Xiaojie, Yan, Hengyi
• Format: Article
• Language: English
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bacteremia - diagnosis; Bacteremia - drug therapy; Bacteremia - microbiology; Bacteremia - mortality; Catheters; Chest Pain - etiology; Clinical characteristics; Cough - etiology; Early Diagnosis; Embolisms; Fever - etiology; Humans; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Mortality; Pulmonary arteries; Pulmonary Embolism - diagnosis; Pulmonary Embolism - drug therapy; Pulmonary Embolism - microbiology; Pulmonary Embolism - mortality; Pulmonary/Respiratory; Risk Factors; Septic pulmonary embolism; Software; Staphylococcal Infections - complications; Staphylococcal Infections - diagnosis; Staphylococcal Infections - drug therapy; Staphylococcal Infections - mortality; Staphylococcus infections; Statistical analysis; Studies; Substance abuse treatment; Systematic review; Treatment Outcome
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2013.10.012

Summary Objectives To describe the clinical characteristics of septic pulmonary embolism in adults in order to improve its diagnosis and treatment. Methods Specific search terms were used for retrieval from commonly used Chinese and English databases and the articles were selected in accordance with the inclusion and exclusion criteria. Cases from the included articles were pooled; then the following parameters were analyzed: major risk factors, clinical manifestations, imaging findings, characteristics of pathogenic microorganisms, complications and other clinical characteristics. Results After strictly selected by the inclusion and exclusion criteria , 76 articles were selected (2 Chinese articles and 74 English articles) that described 168 cases. The major risk factors for SPE were intravenous drug use ( n  = 44), intravascular indwelling catheter ( n  = 21) and skin or soft tissue purulent infection ( n  = 10). The most frequent clinical manifestations were fever ( n  = 144), dyspnea ( n  = 81), chest pain ( n  = 82) and cough ( n  = 69). Chest CT showed multiple peripheral nodules in both lungs ( n  = 89), cavitation ( n  = 75), focal or wedge-shaped infiltrates ( n  = 48) and pleural effusion ( n  = 40). Echocardiography often revealed vegetations ( n  = 52). Blood cultures grew methicillin-resistant Staphylococcus aureus (MRSA) ( n  = 27), methicillin-sensitive Staphylococcus aureus (MSSA) ( n  = 48) and Candida ( n  = 6). Seventeen cases died and 101 cases were cured. Conclusions SPE is a rare disease without specific clinical manifestations. For high-risk groups, such as intravenous drug users or patients with intravascular indwelling catheters, fever and imaging findings of multiple nodules or local infiltrates, with or without cavitation, are highly suggestive of SPE. Early diagnosis and prompt antimicrobial therapy or surgical intervention can lead to a successful treatment outcome.