Family Medicine, Internal Medicine and Surgery Case 2

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Iowa Lutheran Family Medicine Residency Program

PIAC Case Series

Case 02 - Doris, 65 years old

Doris is a 65 who underwent R hemicolectomy and diverting loop ileostomy for cecal tumor with perforation and peritontitis

She received antibiotics for 5 days; she has not tolerated oral/enteral nutrition and has required TPN; post-op day 6 the patient develops T=38.8 and WBC = 15K

The following day 2 of 2 blood cultures are positive for gm + cocci

Questions


1). How is a central-line associated bloodstream infection (CLA-BSI) diagnosed?

2). What organisms in blood culture are possible contaminants? Which organisms should definitely not be considered contaminants?

Consider: 

  • Staphylococcus aureus
  • Staphylococcus epidermidis (CONS)
  • Pseudomonas aeruginosa
  • Bacillus species
  • Candida albicans
  • Diptheroids

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