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Journal of Microbiology, Immunology,... Aug 2020Lemierre's syndrome, also known as post-anginal septicemia or necrobacillosis, is characterized by bacteremia, internal jugular vein thrombophlebitis, and metastatic... (Review)
Review
Lemierre's syndrome, also known as post-anginal septicemia or necrobacillosis, is characterized by bacteremia, internal jugular vein thrombophlebitis, and metastatic septic emboli secondary to acute pharyngeal infections. Modern physicians have "forgotten" this disease. The most common causative agent of Lemierre's syndrome is Fusobacterium necrophorum, followed by Fusobacterium nucleatum and anaerobic bacteria such as streptococci, staphylococci, and Klebsiella pneumoniae. The causative focus mostly originated from pharyngitis or tonsillitis, accounting for over 85% of the cases of Lemierre's syndrome. Pneumonia or pleural empyema is the most common metastatic infection in Lemierre's syndrome. Antimicrobial therapy should be prescribed for 3-6 weeks. The treatment regimens include metronidazole and β-lactam antibiotics. In recent years, the antibiotic stewardship program has resulted in decreased antibiotic prescription for upper respiratory tract infections. The incidence of Lemierre's syndrome has increased over the past decade. F. necrophorum is an underestimated cause of acute pharyngitis or tonsillitis. A high index of suspicion is required for the differential diagnosis of acute tonsillopharyngitis with persistent neck pain and septic syndrome.
Topics: Anti-Bacterial Agents; Bacteria; Bacteria, Anaerobic; Communicable Diseases, Emerging; Fusobacterium necrophorum; Humans; Lemierre Syndrome; Pharyngitis; Sepsis
PubMed: 32303484
DOI: 10.1016/j.jmii.2020.03.027 -
Journal of Advanced Nursing Dec 2020The aim of this systematic review and meta-analysis was to summarize and quantify peripheral intravenous catheter-related complications. (Meta-Analysis)
Meta-Analysis Review
AIMS
The aim of this systematic review and meta-analysis was to summarize and quantify peripheral intravenous catheter-related complications.
DESIGN
This systematic review is reported by means of the Cochrane process for randomized controlled trials and the Meta-analysis of Observation Studies in Epidemiology for cohort studies.
DATA SOURCES
The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases, clinical trial registries such as ClinicalTrials.gov and the reference list of included studies were searched from 2000 -April 2019.
REVIEW METHODS
Using a purpose designed data extraction tool, two authors independently identified studies for full review, data extraction and quality assessment. Dichotomous outcomes were pooled after Freeman-Tukey double arcsine transformation using random-effects meta-analysis; estimates of heterogeneity were taken from inverse-variance fixed-effect models.
RESULTS
Seventy observational studies and 33 randomized controlled trials were included (76,977 catheters). Peripheral intravenous catheter-related complications were as follows: phlebitis (with definition) 19.3%, phlebitis (without definition) 4.5%, infiltration/extravasation 13.7%, occlusion 8%, leakage 7.3%, pain 6.4% and dislodgement 6.0%. Subgroup analysis found infiltration/extravasation for emergency department-inserted catheters was significantly higher (25.2%; p = .022) than for those inserted in other departments and pain was significantly higher (p < .001) in countries with developing economies compared with developed economies.
CONCLUSION
Peripheral intravenous catheter complications are unacceptably common worldwide. This review suggests substantial and multi-specialty efforts are needed to address the sequalae associated with complications. The potential benefits for patients and health services are considerable if complications are reduced.
IMPACT
Peripheral intravenous complications interrupt important treatment which can be distressing for patients and result in longer hospital stays with increased healthcare costs. This review found phlebitis and infiltration are the most prevalent reason for catheter failure. These results provide nurses with a strong evidence base for the development of effective interventions for practice which are vital for preventing poor outcomes for patients with peripheral intravenous catheters.
Topics: Adult; Catheterization, Peripheral; Catheters; Humans; Infusions, Intravenous; Phlebitis
PubMed: 33016412
DOI: 10.1111/jan.14565 -
Revista Da Escola de Enfermagem Da U S P 2022To identify risk factors for peripheral intravenous catheter-related phlebitis in adult patients. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To identify risk factors for peripheral intravenous catheter-related phlebitis in adult patients.
METHOD
This is a post hoc analysis of a randomized clinical trial, totaling 1,319 patients. Demographic and clinical variables related to therapy and phlebitis were investigated. For data analysis, frequencies, measures of central tendency and dispersion were calculated, and Pearson's chi-square test and Fisher's exact test were used, with logistic regression, ROC curve, and Odds Ratio calculation (95% confidence interval; 5% significance level) being implemented.
RESULTS
Of the 1,319 participants, 80 (6.1%) developed phlebitis. The following were associated with the occurrence of phlebitis: reduced mobility (p = 0.015), family history of deep vein thrombosis (p = 0.05), catheterization of veins on the back of the hand (p = 0.012), pain (p < 0.01), Amoxicillin-Potassium Clavulanate (p = 0.015), and Omeprazole Sodium (p = 0.029).
CONCLUSION
Risk factors for phlebitis involved intrinsic and extrinsic factors to the patient, indicating preventive nursing interventions such as promoting patient mobility, not catheterizing veins in the dorsal arch of the hand, cautious infusion of risk drugs, and valuing pain complaints.
Topics: Adult; Catheterization, Peripheral; Catheters; Humans; Pain; Phlebitis; Risk Factors
PubMed: 35724261
DOI: 10.1590/1980-220X-REEUSP-2021-0398en -
The incidence and risk of infusion phlebitis with peripheral intravenous catheters: A meta-analysis.The Journal of Vascular Access May 2020Phlebitis is a common complication associated with the use of peripheral intravenous catheters. The aim of this study was to estimate the incidence of phlebitis with... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Phlebitis is a common complication associated with the use of peripheral intravenous catheters. The aim of this study was to estimate the incidence of phlebitis with peripheral intravenous catheter use and to identify risk factors for phlebitis development.
METHOD
Literature survey was conducted in electronic databases (CINAHL, Embase, Google Scholar, Ovid, and PubMed), and studies were included if they used peripheral intravenous catheter for therapeutic or volumetric infusion and reported phlebitis incidence rates. Random effects meta-analyses were performed to obtain overall and subgroup phlebitis incidence rates and odds ratio between males and females in phlebitis incidence.
RESULTS
Thirty-five studies were included (20,697 catheters used for 15,791 patients; age 57.1 years (95% confidence interval: 55.0, 59.2); 53.9% males (95% confidence interval: 42.3, 65.5)). Incidence of phlebitis was 30.7 per 100 catheters (95% confidence interval: 27.2, 34.2). Incidence of severe phlebitis was 3.6% (95% confidence interval: 2.7%, 4.6%). Incidence of phlebitis was higher in non-intervened (30% (95% confidence interval: 27%, 33%)) than in intervened (21% (95% confidence interval: 15%, 27%)) groups, and with Teflon (33% (95% confidence interval: 25%, 41%)) than Vialon (27% (95% confidence interval: 21%, 32%)) cannula use. Odds of developing phlebitis was significantly higher in females (odds ratio = 1.42 (95% confidence interval: 1.05, 1.93); p = 0.02). Longer dwelling time, antibiotics infusion, female gender, forearm insertion, infectious disease, and Teflon catheter are important risk factors for phlebitis development identified by the included studies.
CONCLUSION
Incidence of phlebitis with the use of peripheral intravenous catheters during infusion is 31%. Severe phlebitis develops in 4% of all patients. Risk of phlebitis development can be reduced by adapting appropriate interventions.
Topics: Adult; Aged; Aged, 80 and over; Catheterization, Peripheral; Female; Humans; Incidence; Infusions, Intravenous; Male; Middle Aged; Phlebitis; Risk Assessment; Risk Factors; Severity of Illness Index; Young Adult
PubMed: 31547791
DOI: 10.1177/1129729819877323 -
Nursing Open Mar 2023To systematically evaluate the efficacy of different topical treatments for PVC-related phlebitis in hospital in-patients. (Meta-Analysis)
Meta-Analysis Review
AIM
To systematically evaluate the efficacy of different topical treatments for PVC-related phlebitis in hospital in-patients.
DESIGN
A systematic review and meta-analysis.
METHODS
A selection was made of experimental and quasi-experimental studies published in English or Spanish. These should provide data on the degree of phlebitis, pain and infiltration (means and standard deviations, mainly) of hospitalized patients with phlebitis secondary to peripheral venous catheter. All those studies that reflected systemic or exclusive prevention treatments were excluded. Searches were from inception to April 2020. The date of data collection was from December 2020 to May 2021. The selection criteria were based on the PICOS model. Risk of bias was assessed using the Cochrane Collaboration tool.
RESULTS
Twelve studies (726 patients) met the inclusion criteria. With respect to the decrease in the degree of phlebitis, was found ichthammol glycerine, followed by heparinoids. As for degree of pain, sesame oil obtained the most marked reduction. In terms of degree of infiltration, heparinoids and ichthammol glycerine were the only products to achieve a statistically significant reduction. The most important limitations are the low quantity and quality of the trials included. Insufficient data are available to draw valid conclusions about the efficacy of any treatment.
Topics: Humans; Heparinoids; Glycerol; Catheters; Phlebitis
PubMed: 36335576
DOI: 10.1002/nop2.1449 -
Practical Neurology Oct 2021Lemierre's syndrome is a rare and potentially life-threatening condition that follows an oropharyngeal infection, typically from and usually affects healthy adolescents...
Lemierre's syndrome is a rare and potentially life-threatening condition that follows an oropharyngeal infection, typically from and usually affects healthy adolescents or young adults. The characteristic features are septic thrombophlebitis of the internal jugular vein and septic embolism leading to multiorgan involvement, commonly the brain, lungs and bones. We report a man with presenting symptoms suggesting hemicrania continua, whose initial imaging showed no features of dural venous sinus or jugular thrombosis. Two weeks later, he had fever, sore throat, cervical lymphadenopathy and grew from peripheral blood cultures. Further imaging identified thrombosis of the internal jugular vein and cerebral venous sinuses, with multifocal cavitating lung lesions. Following antibiotics and anticoagulation, he recovered without residual deficits. Lemierre's syndrome when recognised and treated early has a good prognosis but delayed treatment may result in significant morbidity or mortality.
Topics: Actinomycetaceae; Adolescent; Fusobacterium necrophorum; Humans; Lemierre Syndrome; Male; Thrombophlebitis; Young Adult
PubMed: 33963085
DOI: 10.1136/practneurol-2021-002928 -
International Journal of Nursing Studies Mar 2024Peripheral intravenous catheters are the most frequently used invasive device in nursing practice, yet are commonly associated with complications. We performed a... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Peripheral intravenous catheters are the most frequently used invasive device in nursing practice, yet are commonly associated with complications. We performed a systematic review to determine the prevalence of peripheral intravenous catheter infection and all-cause failure.
METHODS
The Cochrane Library, PubMed, CINAHL, and EMBASE were searched for observational studies and randomised controlled trials that reported peripheral intravenous catheter related infections or failure. The review was limited to English language and articles published from the year 2000. Pooled estimates were calculated with random-effects models. Meta-analysis of observation studies in epidemiology guidelines and the Cochrane process for randomised controlled trials were used to guide the review. Prospero registration number: CRD42022349956.
FINDINGS
Our search retrieved 34,725 studies. Of these, 41 observational studies and 28 randomised controlled trials (478,586 peripheral intravenous catheters) met inclusion criteria. The pooled proportion of catheter-associated bloodstream infections was 0.028 % (95 % confidence interval (CI): 0.009-0.081; 38 studies), or 4.40 catheter-associated bloodstream infections per 100,000 catheter-days (20 studies, 95 % CI: 3.47-5.58). Local infection was reported in 0.150 % of peripheral intravenous catheters (95 % CI: 0.047-0.479, 30 studies) with an incidence rate of 65.1 per 100,000 catheter-days (16 studies; 95 % CI: 49.2-86.2). All cause peripheral intravenous catheter failure before treatment completion occurred in 36.4 % of catheters (95 % CI: 31.7-41.3, 53 studies) with an overall incidence rate of 4.42 per 100 catheter days (78,891 catheter days; 19 studies; 95 % CI: 4.27-4.57).
INTERPRETATION
Peripheral intravenous catheter failure is a significant worldwide problem, affecting one in three catheters. Per peripheral intravenous catheter, infection occurrence was low, however, with over two billion catheters used globally each year, the absolute number of infections and associated burden remains high. Substantial and systemwide efforts are needed to address peripheral intravenous catheter infection and failure and the sequelae of treatment disruption, increased health costs and poor patient outcomes.
Topics: Humans; Phlebitis; Catheter-Related Infections; Catheters; Catheterization, Peripheral; Sepsis
PubMed: 38142634
DOI: 10.1016/j.ijnurstu.2023.104673 -
Infection, Disease & Health Aug 2019Evidence-based bundles have reduced central line bloodstream infection rates in adult intensive care units. To tackle peripheral intravenous catheter (PIVC) bloodstream... (Meta-Analysis)
Meta-Analysis
Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: A systematic review.
BACKGROUND
Evidence-based bundles have reduced central line bloodstream infection rates in adult intensive care units. To tackle peripheral intravenous catheter (PIVC) bloodstream infection, many hospitals have implemented PIVC insertion and maintenance bundles. However, the efficacy of PIVC bundles in preventing PIVC complications and infection in hospital patients is uncertain. The aim of this paper is to synthesize evidence on the effectiveness of PIVC insertion and maintenance bundles on preventing adverse events.
METHODS
In this systematic review, we searched multiple electronic databases, trial registries, and grey literature for eligible studies published in English (January 2000-December 2018) to identify intervention studies evaluating PIVC insertion or maintenance bundles with two or more components. Search terms: peripheral intravenous catheter/cannula, insertion, maintenance, bundle, infection, infiltration, extravasation, dislodgement, thrombosis, occlusion, and phlebitis. Two reviewers independently conducted data extraction and quality assessments using the Downs and Black checklist.
RESULTS
Of 14,456 records screened, 13 studies (6 interrupted time-series, 7 before-and-after) were included. Insertion and maintenance bundles included multiple components (2-7 items per bundle). Despite testing different bundles, 12 studies reported reductions in phlebitis and bloodstream infection, and one study reported no change in bloodstream infection and an increase in phlebitis rate. Methodological quality of all studies ranked between 'low' and 'fair'.
CONCLUSIONS
The effect of PIVC bundles on PIVC complications and bloodstream infection rates remains uncertain. Standardisation of bundle components and more rigorous studies are needed. PROSPERO registration number: CRD42017075142.
Topics: Bacteremia; Catheter-Related Infections; Catheterization, Peripheral; Evidence-Based Practice; Hospitalization; Humans; Phlebitis
PubMed: 31005606
DOI: 10.1016/j.idh.2019.03.001 -
Ugeskrift For Laeger Aug 2023Lemierre's syndrome is rare and characterized by an oropharyngeal infection with thrombophlebitis of the internal jugular vein (IJV). Septic microemboli can spread to...
Lemierre's syndrome is rare and characterized by an oropharyngeal infection with thrombophlebitis of the internal jugular vein (IJV). Septic microemboli can spread to the lungs or abdomen. This case describes a patient who presented with a sore throat, unilateral swelling on the neck and diffuse abdominal pain. Imaging showed a thrombus in the right IJV. The patient developed septic shock and was treated with antibiotics, anticoagulants, and intensive care support. The most common causative organism is Fusobacterium necrophorum. Early diagnosis and treatment are crucial for reducing mortality.
Topics: Humans; Lemierre Syndrome; Abdominal Pain; Anti-Bacterial Agents; Anticoagulants; Critical Care
PubMed: 37622605
DOI: No ID Found -
Presse Medicale (Paris, France : 1983) Apr 2020IgG4-related disease (IgG4-RD) has been accepted as a distinct entity in various fields. It is being increasingly diagnosed and treated in routine practice. However,... (Review)
Review
IgG4-related disease (IgG4-RD) has been accepted as a distinct entity in various fields. It is being increasingly diagnosed and treated in routine practice. However, difficulties are still associated with the diagnostic process. Serum IgG4 elevations and imaging studies are useful, but not entirely diagnostic for this condition. Therefore, a pathological examination still plays an important role. Three characteristic microscopic changes are dense lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis. IgG4 immunostaining reveals many IgG4-positive plasma cells and an IgG4/IgG-positive cell ratio of more than 40%. In addition to the number and ratio of IgG4-positive plasma cells, the diffuse distribution of positive plasma cells needs to be confirmed because IgG4-positive plasma cells may focally aggregate in many other conditions. In small biopsy samples, it is important to recognize not only characteristic findings, but also microscopic changes that are unlikely to occur in IgG4-RD because the identification of the latter findings leads to the exclusion of this condition. Another challenging field regards the diagnosis of long-standing disease. Along with disease progression, inflammatory infiltrate decreases, while storiform fibrosis and obliterative phlebitis are suspected to persistently exist. Therefore, the recognition of the latter two findings will be a diagnostic clue. Given the general suspicion that IgG4-RD has recently been over-diagnosed, precise tissue examinations based on the proposed standards and close clinicopathological correlations are crucial.
Topics: B-Lymphocytes; Biopsy; Castleman Disease; Diagnosis, Differential; Fibrosis; Histiocytosis, Sinus; Humans; Immunoglobulin G; Immunoglobulin G4-Related Disease; Immunohistochemistry; Phlebitis; Plasma Cells; T-Lymphocytes
PubMed: 32234381
DOI: 10.1016/j.lpm.2020.104014