Khan E A, Correa A G, Baker C J
Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Pediatr Infect Dis J. 1997 Jan;16(1):63-7. doi: 10.1097/00006454-199701000-00014.
To determine the clinical and diagnostic features, complications, management and prevention of superficial suppurative thrombophlebitis (ST) in children < 18 years of age.
A retrospective review of medical records was performed for patients in two urban hospitals from January 1, 1985, through June 30, 1995, with a discharge diagnosis of phlebitis.
We identified 21 patients, including 12 neonates, with ST. The majority had underlying medical conditions or preceding invasive procedures and administration of broad spectrum antibiotics or total parenteral nutrition as possible predisposing factors. More than two-thirds had localizing signs (swelling, erythema, induration or a palpable cord); one-third had purulent drainage from the vein. Septicemia was present in one-third of patients. Fever and tenderness were present in older children. Nearly one-half had involvement of an upper extremity. Cultures of vein (63%), blood (67%) or abscess (86%) grew pathogens in most. Gram-positive organisms were predominant; Staphylococcus aureus was isolated from 44%, Gram-negative enterics from 16.7% and Candida species from another 16.7% of patients. Eleven children had vein excision, whereas 10 had only incision and drainage. Complications, including death in one patient, occurred in 33% but could not be correlated with age or method of surgical intervention.
ST is a rare but serious nosocomial infection in infants and children that results in substantial morbidity. It should be suspected in any hospitalized child who is or was receiving intravenous fluids and who has fever, localizing signs or persistent bacteremia. Prompt vein excision, with adjunctive antimicrobial therapy, is the recommended treatment.
