What is the prognosis of 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 thrombophlebitis is a relatively rare disease that encompasses an array of clinical entities, so data on mortality rates are scarce. Needless to say, it is a serious and dangerous disease, because the infection takes root in the central or peripheral venous system and can readily progress to sepsis and shock.

Metastatic foci of infection are common, with septic pulmonary emboli, infective endocarditis, septic emboli to the central nervous system, osteomyelitis, septic arthritis, and even arteritis all adding to the morbidity and mortality burden of this disease. [14] In fact, major complications occur in about one third of all patients with catheter-associated peripheral septic phlebitis. [14]

Some entities of deep venous thrombosis carry uniquely high mortality rates, with pylephlebitis portending a mortality rate of 32% in one case series of 19 patients. [16] Thrombophlebitis due to Candida species, as seen with central venous catheters, boasts a 22% death rate. [17]

The death rate remains extremely high for patients with septic thrombophlebitis of the intracranial dural sinuses; septic cavernous sinus thrombosis carries a mortality rate of 30%, while 78% of patients with infection of the superior sagittal sinus die even with appropriate antibiotic treatment. Serious complications in survivors include ocular palsies, hemiparesis, blindness, and pituitary insufficiency. [12]

Notably, however, pelvic and jugular thrombophlebitis appear to have become less deadly over the years. Early twentieth century data reported a 50% mortality rate in the setting of pelvic thrombophlebitis, whereas one series following more than 44,000 deliveries demonstrated no major complications and not a single death. [15]  Lemierre syndrome was previously reported to have a high incidence of mortality; however, with the advent of antibiotics, a meta-analysis of patients from 1980-2017 found the mortality rate was closer to 4.1%.


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