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Sunday, February 26, 2017

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Q: What is the most common causative organism associated with non-central line associated jugular vein suppurative thrombophlebitis?


Answer: Fusobacterium necrophorum

Jugular vein suppurative thrombophlebitis, commonly known as Lemierre's syndrome is usually caused by either central line or extension of oropharyngeal infection. Causative organisms are different respectively.

Clinical significance: Initial empiric treatment for Fusobacterium necrophorum should include a beta-lactamase resistant beta-lactam antibiotic like ampicillin-sulbactam, piperacillin-tazobactam, ticarcillin-clavulanate or a carbapenem. Jugular vein suppurative thrombophlebitis secondary to central line catheter should include vancomycin in the initial empiric therapy to cover skin flora.

Later antibiotics can be tailored and narrowed according to culture and sensitivity.



Reference:

1. Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ. The evolution of Lemierre syndrome: report of 2 cases and review of the literature. Medicine (Baltimore) 2002; 81:458. 

2. Hagelskjaer Kristensen L, Prag J. Lemierre's syndrome and other disseminated Fusobacterium necrophorum infections in Denmark: a prospective epidemiological and clinical survey. Eur J Clin Microbiol Infect Dis 2008; 27:779.






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