From the Guidelines
Septic emboli are caused by infected material, typically blood clots containing bacteria or fungi, that break off from an infection site and travel through the bloodstream to lodge in distant organs, with the most common causes including infective endocarditis, infected intravenous catheters, septic thrombophlebitis, and intravenous drug use, as stated in the 2014 European Heart Journal guidelines 1.
Causes of Septic Emboli
- Infective endocarditis (infection of heart valves)
- Infected intravenous catheters
- Septic thrombophlebitis
- Intravenous drug use
- Less common sources include dental infections, skin infections, and septic arthritis
Treatment of Septic Emboli
- Treatment requires a dual approach: antimicrobial therapy and source control.
- Empiric broad-spectrum antibiotics should be started immediately after blood cultures are drawn, typically including vancomycin (15-20 mg/kg IV every 8-12 hours) plus either piperacillin-tazobactam (4.5g IV every 6-8 hours) or a carbapenem like meropenem (1g IV every 8 hours), as recommended by the Surviving Sepsis Campaign guidelines 1.
- Therapy should then be narrowed based on culture results, with treatment duration typically 4-6 weeks for endocarditis-related emboli or 2-4 weeks for other sources.
- Source control is equally critical and may require procedures such as removal of infected catheters, drainage of abscesses, or heart valve replacement in cases of endocarditis, as suggested by the guidelines for the management of intravascular catheter-related infections 1.
- Anticoagulation is generally avoided unless specifically indicated, as stated in the guidelines for the management of intravascular catheter-related infections 1.
- Patients require close monitoring with serial blood cultures to ensure infection clearance, and imaging studies to assess for complications like abscesses or metastatic infections.
- Early intervention is essential as septic emboli can lead to serious complications including stroke, pulmonary infarction, or multi-organ failure.
From the Research
Causes of Septic Emboli
- Septic emboli can be caused by Staphylococcus aureus bacteremia, which can lead to complications such as endocarditis and septic pulmonary emboli 2, 3, 4
- Deep tissue infections, such as pyomyositis, osteomyelitis, and prostatic abscess, can also lead to septic pulmonary emboli and bacteremia associated with community-acquired methicillin-resistant Staphylococcus aureus 4
- Extrapulmonary septic foci, including septic arthritis, soft tissue infection, and deep vein thrombosis, can be identified in patients with septic pulmonary embolism 3
Treatment of Septic Emboli
- Daptomycin is FDA-approved for S. aureus bacteremia and right-sided endocarditis, but its role in the setting of septic pulmonary emboli is still controversial 2
- Vancomycin is the mainstay of therapy for S. aureus infections, but salvage therapy is frequently required due to persistence of infection or drug toxicity 2
- Early diagnosis, appropriate antibiotic treatment, and respiratory support are important in patients with septic pulmonary embolism, especially in low-income settings where timely access to healthcare and diagnostic resources may be limited 3
- Management of Staphylococcus aureus infections requires a comprehensive approach, covering epidemiology, pathophysiology, clinical manifestations, and management of various clinical entities, including bacteremia, infective endocarditis, and device-related infections 5