Suzuki Yasuhiro, Kuriyama Akira
Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
Ann Med Surg (Lond). 2024 Mar 4;86(4):2176-2180. doi: 10.1097/MS9.0000000000001886. eCollection 2024 Apr.
Infections of inferior vena cava (IVC) filters are rare. The authors present a case of IVC filter infection following concurrent emphysematous urinary tract infections that was finally treated with prolonged suppressive antibiotic therapy (PSAT).
A 68-year-old man with pemphigoid and type 2 diabetes mellitus, who had undergone IVC filter placement, was transferred with decreased consciousness, respiratory failure, and hypotension. Computed tomography revealed gas in the left renal parenchyma and bladder wall, suggesting a diagnosis of concurrent emphysematous pyelonephritis and cystitis. While blood and urine cultures were positive for extended-spectrum beta-lactamase-producing , and the patient's general condition improved with proper antibiotic therapy, bacteremia persisted until day 10 from symptom onset. After ruling out abscesses and infectious endocarditis, the cause of persistent bacteremia was suspected to be IVC filter infection. As the IVC had been placed 12 years before, the authors did not remove it to avoid complications. PSAT with sulfamethoxazole-trimethoprim was continued after 6 weeks of intravenous antibiotic therapy. The patient had an uneventful course over the year following hospital discharge.
PSAT is considered for device-related infections in patients with cardiac assist devices and artificial joints when the infection flares up or recurs even after antibiotic treatment of an adequate duration. There is no consensus regarding the optimal duration of antimicrobial therapy for IVC filter infections.
Infections of implanted devices, such as IVC filters, secondary to severe infections can cause persistent bacteremia. PSAT may be an alternative option to treat IVC filter infection, when the IVC filter is considered difficult to remove.
下腔静脉（IVC）滤器感染较为罕见。作者报告了一例在并发气肿性尿路感染后发生的IVC滤器感染病例，最终通过长期抑制性抗生素治疗（PSAT）得以治愈。
一名68岁患有类天疱疮和2型糖尿病的男性，曾接受IVC滤器置入术，因意识减退、呼吸衰竭和低血压而被转诊。计算机断层扫描显示左肾实质和膀胱壁有气体，提示并发气肿性肾盂肾炎和膀胱炎。血液和尿液培养显示产超广谱β-内酰胺酶阳性，患者经适当抗生素治疗后一般状况有所改善，但菌血症一直持续到症状出现后第10天。在排除脓肿和感染性心内膜炎后，怀疑持续菌血症的原因是IVC滤器感染。由于IVC滤器是12年前置入的，作者未将其取出以避免并发症。在静脉抗生素治疗6周后，继续使用磺胺甲恶唑-甲氧苄啶进行PSAT。患者出院后一年病情平稳。
对于心脏辅助装置和人工关节患者发生的与装置相关的感染，即使在足够疗程的抗生素治疗后感染仍复发或加重时，会考虑采用PSAT。对于IVC滤器感染的最佳抗菌治疗持续时间尚无共识。
严重感染继发的植入装置感染，如IVC滤器感染，可导致持续菌血症。当认为IVC滤器难以取出时，PSAT可能是治疗IVC滤器感染的一种替代选择。
