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July 1976

Septic Nonsuppurative Thrombophlebitis

Author Affiliations

Palo Alto, Calif
Madison, Wis

Arch Surg. 1976;111(7):832. doi:10.1001/archsurg.1976.01360250108029

To the Editor.—In a recent article, "Septic Nonsuppurative Thrombophlebitis" (Arch Surg 111:122, 1976), Zinner and colleagues described 11 patients with cannula-associated Gram-negative bacillary sepsis refractory to cannula removal and antimicrobial therapy. Metal ("scalp-vein") needles were implicated in seven cases. Clinical remission followed resection of mildly inflamed veins; in each case culture of the vein yielded the blood pathogen. The authors concluded that the thrombophlebitic veins constituted the source of persistent septicemia although no suppuration or organisms were identified histologically.

This report appropriately re-emphasizes iatrogenic hazards of infusion therapy. However, we have reservations about the interpretation of data presented:

  1. Septicemia, and especially septic thrombophlebitis, arising from use of metal needles has been rare.1-33 Only one case of needle-related septicemia was detected among 535 patients in five prospective studies. Moreover, prior to this series, a total of only five cases of needle-related septicemia had been reported2; one was linked to

Maki DG, Goldmann DA, Rhame FS:  Infection control in intravenous therapy .  Ann Intern Med 79:867-887, 1973.Crossref
Maki DG, Drinka RJ, Davis TE:  Suppurative phlebitis of an arm vein from a "scalp-vein needle."  N Engl J Med 202:1116-1117, 1975.Crossref
Harbin RL, Schaffner W:  Septicemia associated with scalp-vein needles .  South Med J 66:638-640, 1973.Crossref
Maki DG, Rhame FS, Mackel DC, et al:  Nationwide epidemic of septicemia caused by contaminated infusion products: I. Epidemiologic and clinical features .  Am J Med 60:471-485, 1976.Crossref
Maki DG, Martin WT:  Nationwide epidemic of septicemia caused by contaminated infusion products: IV. Growth of microbial pathogens in fluids for intravenous infusion .  J Infect Dis 131:267-272, 1975.Crossref
 Primary bacteremia—Illinois .  Morbidity Mortality Weekly Rep 25:110-111, 1976.