Family Medicine, Internal Medicine and Surgery Cases

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Iowa Lutheran Family Medicine Residency Program

PIAC Case Series

ANSWERS

Case 02 - Doris, 65 years old

Doris is a 65 who underwent R hemicolectomy and diverting loop ilestomy 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

Answers

 CLA-BSI diagnosed by:

  • + blood culture with recognized pathogen (e.g. S. aureus), central line in place and no other evident source
  • If blood culture + for pathogen of uncertain significance (e.g. CONS), need 2 positive cultures and sign/symptom (fever, chills, hypotension)
  • Organisms likely contaminants = corynebacterium ("diptheroids"), bacillus (non-anthracis), propionibacterium
  • Possible contaminants = coagulase-negative staph
  • NOT contaminants = Staph aureus, Candida, Pseudomonas

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