Clinical and radiographic spectrum of septic pulmonary embolism

• Published in: Archives of disease in childhood 2002-10, Vol.87 (4), p.312-315
• Main Authors: Wong, K S, Lin, T Y, Huang, Y C, Hsia, S H, Yang, P H, Chu, S M
• Format: Article
• Language: English
• Subjects: Adolescent; Antibiotics; Bacterial diseases; Bacterial diseases of the respiratory system; Biological and medical sciences; CAMRSA; Causes of; Child; Child health; Child, Preschool; Children; Clinical Diagnosis; community acquired methicillin resistant S aureus; community acquired methicillin resistant Staphylococcus aureus; Community Relations; Community-Acquired Infections - complications; Computed tomography; Ear diseases; Embolisms; Female; Fever; Health aspects; Hospitals; Human bacterial diseases; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - diagnostic imaging; Infant, Premature, Diseases - microbiology; Infant, Premature, Diseases - therapy; Infectious diseases; Male; Medical instruments; Medical sciences; Methicillin Resistance; methicillin resistant S aureus; Mortality; MRSA; Nosocomial infections; Original; Ostomy; Pain; Patient outcomes; Patients; Pulmonary embolism; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - microbiology; Pulmonary Embolism - therapy; Retrospective Studies; Risk factors; septic pulmonary embolism; Staphylococcal Infections - complications; Staphylococcus aureus - drug effects; Staphylococcus infections; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.87.4.312

Aims: To review the clinical presentation, radiographic findings, and outcome of therapy in children with septic pulmonary embolism. Methods: Retrospective analysis of patients in a tertiary paediatric facility in northern Taiwan. Results: Ten children were identified with septic pulmonary emboli in a four year retrospective chart review between 1998 and 2001. Seven were immunocompetent, two were premature infants, one had β thalassemia major. Seven had community acquired staphylococcal infections and bacteraemia, of which six were methicillin resistant Staphylococus aureus (MRSA) isolates. Five had soft tissue infections, two bone infections, one suppurative otitis media, one catheter related infection, and one unknown foci of infection. Multiple and bilateral nodular pulmonary parenchymal lesions were common on plain chest radiographs, but chest computed tomography scans showed the additional findings of a “vessel sign” and central cavitations, confirming the existence of septic pulmonary embolism. Conclusions: Community acquired MRSA infections occurred in seven patients with septic pulmonary embolism but without predisposing high risk factors. Critically ill children with skin, soft tissue, or bone infections, when associated with septic pulmonary embolism in an area with a high rate of MRSA, should be empirically treated with glycopeptides (such as vancomycin or teicoplanin) before susceptibility results are known, in order to minimise morbidity and avoid mortality.