Septic deep venous thrombosis in intravenous drug users.

OBJECTIVE

To review diagnostic and therapeutic experience in seven patients with septic deep vein thrombosis (DVT) after intravenous use of illicit drugs.

METHODS

Retrospective review of medical records and prospective data collection in intravenous drug users (IVDU) who presented with a confirmed diagnosis of DVT and sepsis during a period of 18 months in a single institution.

RESULTS

Of seven long-term IVDU (age 24-40 years), who had repeatedly attempted venous access to proximal veins, five had femoral DVT and one each jugular and brachial DVT. All DVT were confirmed by contrast-enhanced helical CT or ultrasonography. Median C-reactive protein (CRP) was 215 mg/l (range 76-386). Multiple blood cultures grew Gram-positive bacteria in 7 of 8 patients, chiefly Staphylococcus aureus, confirming an intravascular infection with continuous bacteraemia. Therapy consisted of intravenous b-lactamase-resistant penicillin until normalisation of CRP (3-4 weeks), initially combined with an aminoglycoside for a few days. The mean defervescence time was 7.4 days (range 3-12). All patients were given intravenous heparin overlapping with oral anticoagulation without major side effects. Surgical exploration of the venous vasculature was never necessary. Mean hospital stay was 25.7 days (range 10-47).

CONCLUSION

Septic DVT in IVDU is a potentially life-threatening disorder that may become more frequent as the number of long-term IVDU increases. Helical CT or colour-coded Doppler ultrasound is the confirmatory imaging procedure of choice. Empirical antibiotic therapy should include a ss-lactamase-resistant penicillin since S. aureus is the most common pathogen isolated. Anticoagulation can be safely initiated once the diagnosis of DVT is confirmed. Surgery is necessary only in rare instances of septic DVT.