ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Septic Pulmonary Emboli: A Marker for Mortality in IVDU
Session Title
TP93 - TP093 NEW DEVELOPMENTS IN DIAGNOSTICS AND TREATMENTS OF PNEUMONIA
Abstract
A3879 - Septic Pulmonary Emboli: A Marker for Mortality in IVDU
Author Block: S. Dachert1, M. Weir2; 1Internal Medicine, Temple University Hospital, Philadelphia, PA, United States, 2Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.
Introduction/ Rationale
The US opioid epidemic continues to ravage America’s poorest cities. A deadly complication of intravenous drug use (IVDU) is the development of septic pulmonary emboli (SPE). SPE occur when emboli containing pathogens lodge in the distal pulmonary vessels creating local infarcts and abscess formation. Common etiologies include infected central venous catheters, pelvic thrombophlebitis, dental abscesses and IVDU. At present, no large-scale studies have focused on SPE specifically related to IVDU. Methods: Temple University institutional review board approved this study. We undertook a retrospective chart review on patients who presented to our hospital with a history of IVDU and were found to have septic pulmonary emboli (SPE) on CT scan between: 1/1/2017 and 8/30/2019. The electronic medical record (EMR) was queried using ICD-10 billing codes for SPE and IVDU, while excluding codes for Lemierre's syndrome, thrombophlebitis and bacteremia secondary to indwelling catheter. CT Chest imaging was reviewed by an internal medicine resident and pulmonary attending. Embolic disease burden was recorded and compared to radiological report. Echocardiography, microbiology data, in-hospital mortality were reviewed for each subject. Rank sum and logistic regression were performed using the following risk factors: presence of five additional embolic lesions, presence of tricuspid valve vegetation, female sex, presence of MRSA bacteremia.
Results: 100 Patients met inclusion criteria. 60 males, 40 females. Mean age was 37.7 years. Mortality rate was 12%. Survival Group: n=88 (56M, 32F), Median SPE lesions 14 (IQR 6-35), Tricuspid valve vegetations 48/88 (56%), Female Sex 32/40 (80%), Male Sex 56/60 (93%), MRSA bacteremia 41/88 (47%). Pleural Effusion/empyema 35/88 (60%) Deceased Group: Deceased Group: n=12 (4M, 8F) Median SPE lesions 45 (IQR 19-88.5), Tricuspid valve vegetation: 11/12 (92%), Female 8/40 (20%), Male Sex 4/60 (7%). MRSA bacteremia 9/12 (75%) Pleural Effusion/empyema 3/12 (25%) Risk of mortality using logistic regression is listed in Table 1.
Conclusion: Disease burden assessed by the number of SPE nodules was associated with increased mortality. Patients with >50 nodules had a 45% mortality rate. Using logistic regression, we showed an increase in mortality of 12.5% for every additional 5 lesions found on CT thorax. SPE burden, presence of tricuspid valve vegetation, patient sex, and MRSA bacteremia may be useful in predicting in-hospital mortality in patients who inject IV drugs. Presence of pleural complications, including pleural effusions and empyema did not increase risk of mortality.
Author Block: S. Dachert1, M. Weir2; 1Internal Medicine, Temple University Hospital, Philadelphia, PA, United States, 2Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.
Introduction/ Rationale
The US opioid epidemic continues to ravage America’s poorest cities. A deadly complication of intravenous drug use (IVDU) is the development of septic pulmonary emboli (SPE). SPE occur when emboli containing pathogens lodge in the distal pulmonary vessels creating local infarcts and abscess formation. Common etiologies include infected central venous catheters, pelvic thrombophlebitis, dental abscesses and IVDU. At present, no large-scale studies have focused on SPE specifically related to IVDU. Methods: Temple University institutional review board approved this study. We undertook a retrospective chart review on patients who presented to our hospital with a history of IVDU and were found to have septic pulmonary emboli (SPE) on CT scan between: 1/1/2017 and 8/30/2019. The electronic medical record (EMR) was queried using ICD-10 billing codes for SPE and IVDU, while excluding codes for Lemierre's syndrome, thrombophlebitis and bacteremia secondary to indwelling catheter. CT Chest imaging was reviewed by an internal medicine resident and pulmonary attending. Embolic disease burden was recorded and compared to radiological report. Echocardiography, microbiology data, in-hospital mortality were reviewed for each subject. Rank sum and logistic regression were performed using the following risk factors: presence of five additional embolic lesions, presence of tricuspid valve vegetation, female sex, presence of MRSA bacteremia.
Results: 100 Patients met inclusion criteria. 60 males, 40 females. Mean age was 37.7 years. Mortality rate was 12%. Survival Group: n=88 (56M, 32F), Median SPE lesions 14 (IQR 6-35), Tricuspid valve vegetations 48/88 (56%), Female Sex 32/40 (80%), Male Sex 56/60 (93%), MRSA bacteremia 41/88 (47%). Pleural Effusion/empyema 35/88 (60%) Deceased Group: Deceased Group: n=12 (4M, 8F) Median SPE lesions 45 (IQR 19-88.5), Tricuspid valve vegetation: 11/12 (92%), Female 8/40 (20%), Male Sex 4/60 (7%). MRSA bacteremia 9/12 (75%) Pleural Effusion/empyema 3/12 (25%) Risk of mortality using logistic regression is listed in Table 1.
Conclusion: Disease burden assessed by the number of SPE nodules was associated with increased mortality. Patients with >50 nodules had a 45% mortality rate. Using logistic regression, we showed an increase in mortality of 12.5% for every additional 5 lesions found on CT thorax. SPE burden, presence of tricuspid valve vegetation, patient sex, and MRSA bacteremia may be useful in predicting in-hospital mortality in patients who inject IV drugs. Presence of pleural complications, including pleural effusions and empyema did not increase risk of mortality.
