BACKGROUND: To investigate the clinical features of septic pulmonary embolism (SPE) cases and prognostic factors for in-hospital mortality in China.
METHODS: A retrospective analysis was conducted of SPE patients hospitalized between January 2007 and June 2018 in the Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University.
RESULTS: A total of 98 patients with SPE were identified. All patients had bilateral multiple peripheral nodules on chest computed tomography. The most common pathogen found in blood culture was Staphylococcus aureus (10/33, 30.3%). Transthoracic echocardiography was performed in 39 patients and 20 showed vegetations. Bronchoscopy was performed in 24 patients. Bronchoalveolar lavage fluid (BALF) was obtained from 15 patients (62.5%) and showed predominantly polymorphonuclear cell infiltration (52%, range of 48%~ 63%). Four patients received transbronchial lung biopsy, and histopathological examinations revealed suppurative pneumonia and organizing pneumonia. The in-hospital mortality rate was 19.4%. Age (odds ratio [OR] 1.100; 95% confidence interval [CI] 1.035-1.169), hypotension (OR 7.260; 95% CI 1.126-46.804) and ineffective or delay of empirical antimicrobial therapy (OR 7.341; 95% CI 1.145-47.045) were found to be independent risk factors for in-hospital mortality, whereas drainage treatment was found to be a protective factor (OR 0.33; 95% CI 0.002-0.677).
CONCLUSIONS: SPE cases presented with nonspecific clinical manifestations and radiologic features. Blood cultures and bronchoscopy are important measures for early diagnosis and differential diagnosis. There is relationship between primary infection sites and the type of pathogen. Maintaining normal blood pressure and providing timely and appropriate initial antimicrobial therapy for effective control of the infection could improve prognosis.

OBJECTIVE: To compare the clinical and CT characteristics of patients with Klebsiella pneumoniae liver abscess (KPLA), with or without metastatic infection.
METHODS: Clinical information (age, sex, clinical symptoms, underlying disease, hematological parameters, abscess-related mortality) and CT characteristics of abscesses were analyzed to investigate associations with metastatic infection. Metastatic infections were divided into septic pulmonary embolism (SPE) and extra-pulmonary metastatic infection (EMI).
RESULTS: We identified 66 consecutive patients with KPLA. Metastatic infection occurred in 22/66 patients (33.3%); 8/66 (12.1%) patients had SPE, 6/66 (9.09%) patients had EMI; and 8/66 (12.1%) patients had both SPE and EMI. Patients with SPE were younger than patients without SPE (47.7±13.7 y vs.55.6±12.0 y; p=0.03). Unilocular abscess was significantly more common in patients with SPE than the non-SPE group (43.75% vs 18.0%, p=0.036). The mean maximal diameter of EMI was 56.5±21.3 mm and was significantly smaller than that of the non-EMI which was 79.9±31.4 (p=0.011). SPE was significantly associated with development of EMI (50% vs 17.3%, p=0.011).
CONCLUSIONS: Unilocular liver abscess is associated with SPE, and SPE is strongly associated with EMI among patients with KPLA. A maximal diameter of KPLA<55 mm can be used as a predictor of EMI.

OBJECTIVE: To describe the clinical characteristics of septic pulmonary embolism in adults in order to improve its diagnosis and treatment.
METHODS: Specific search terms were used for retrieval from commonly used Chinese and English databases and the articles were selected in accordance with the inclusion and exclusion criteria. Cases from the included articles were pooled; then the following parameters were analyzed: major risk factors, clinical manifestations, imaging findings, characteristics of pathogenic microorganisms, complications and other clinical characteristics.
RESULTS: After strictly selected by the inclusion and exclusion criteria, 76 articles were selected (2 Chinese articles and 74 English articles) that described 168 cases. The major risk factors for SPE were intravenous drug use (n = 44), intravascular indwelling catheter (n = 21) and skin or soft tissue purulent infection (n = 10). The most frequent clinical manifestations were fever (n = 144), dyspnea (n = 81), chest pain (n = 82) and cough (n = 69). Chest CT showed multiple peripheral nodules in both lungs (n = 89), cavitation (n = 75), focal or wedge-shaped infiltrates (n = 48) and pleural effusion (n = 40). Echocardiography often revealed vegetations (n = 52). Blood cultures grew methicillin-resistant Staphylococcus aureus (MRSA) (n = 27), methicillin-sensitive Staphylococcus aureus (MSSA) (n = 48) and Candida (n = 6). Seventeen cases died and 101 cases were cured.
CONCLUSIONS: SPE is a rare disease without specific clinical manifestations. For high-risk groups, such as intravenous drug users or patients with intravascular indwelling catheters, fever and imaging findings of multiple nodules or local infiltrates, with or without cavitation, are highly suggestive of SPE. Early diagnosis and prompt antimicrobial therapy or surgical intervention can lead to a successful treatment outcome.