What causes deep septic thrombophlebitis?

Updated: Oct 05, 2021
  • Author: JE Robyn Hanna, MD, MS; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

Septic pelvic and ovarian vein thrombophlebitides are often puerperal and typically occur within 3 weeks of delivery. [15]  They result from a localized uterine infection, such as endometritis. Damage to the intima of pelvic ileofemoral vessels during vaginal or cesarean delivery is thought to contribute to the process of thrombosis. Hypercoagulability secondary to pregnancy, as well as the venous stasis common in the peripartum state, also contribute. [11]  Pathogens responsible for endometritis, such as streptococci, Enterobacteriaceae, and anaerobes, are likely causative, but cultures are often negative.

Septic thrombophlebitis of the portal vein, known as pylephlebitis, is a rare complication of diverticulitis (found to be the inciting infection in 32% of cases). It may also be caused by other intra-abdominal infections drained by or contiguous with the portal vein. [16]  Local infection of an adjacent structure can cause extravasation of bacteria and toxin-inducing thrombosis and infection. Bacteroides fragilis is the most common pathogen, but other bacteria, such as Escherichia coliKlebsiella species, and other Bacteroides species, are also found. [16]

Septic IVC/SVC thrombophlebitis has been found almost exclusively in the setting of central venous catheter placement with the subsequent development of thrombosis, infection, and worsening systemic disease. However, a case report found an IVC filter to be the nidus of a septic phlebitis. [17]  In addition to Staphylococcus species, other skin flora and fungal pathogens cause a significant portion of infections. Candida albicans is the most common fungal pathogen, but cases have also been attributed to Candida glabrata. [17]

 


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