title: Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes.
abstract: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care.
  The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed.
  Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%). The most common computed tomographic findings included a feeding vessel sign (90%), peripheral nodules without cavities (80%) or with cavities (65%), and peripheral wedge-shaped opacities (75%). The most common primary source of infection was liver abscess (40%), followed by pneumonia (25%). The two most frequent causative pathogens were Klebsiella pneumoniae (50%) and Staphylococcus aureus (35%). Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess.
  Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential.
authors.affiliation: Tainan Municipal Hospital, Department of Critical Care Medicine, Tainan/Taiwan.|Chung-Hwa University of Medical Technology, Department of Nursing, Tainan/Taiwan.
authors.forename: Deng-Wei
authors.initials: DW
authors.lastname: Chou
authors.affiliation: Chung-Hwa University of Medical Technology, Department of Long Term Care, Tainan/Taiwan.
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Wu
authors.affiliation: Tainan Municipal Hospital, Department of Internal Medicine, Tainan/Taiwan.
authors.forename: Kuo-Mou
authors.initials: KM
authors.lastname: Chung
authors.affiliation: Tainan Municipal Hospital, Department of Radiology, Tainan/Taiwan.
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Han
authors.affiliation: Tainan Municipal Hospital, Department of Internal Medicine, Tainan/Taiwan.
authors.forename: Bruno Man-Hon
authors.initials: BM
authors.lastname: Cheung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D001419:Bacteria / Q000302:isolation & purification; D003422:Critical Care / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008100:Liver Abscess / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D009102:Multiple Organ Failure / Q000382:microbiology / Q000401:mortality; D011014:Pneumonia / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric