Weekend case study 2 - difficult to treat bacteraemia

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17 Sep 2016 - General

A middle aged women, with no previous medical history, and not on any medication, was admiited a week ago due to persistent fever. A few days prior to the admission, patient did had a mechanical fall and suffered from some cuts on the skins in her right arm. Her chest x ray , and urine on admission was normal. The 1st blood culture showed methicillin sensitive staphylococcus aureus (MSSA). Patient was given high dose intravenous flucloxacillin to treat her MSSA sepsis. However, around 4-5 days into her treatment, patient was still persistently spike of temperature and her blood culture and sensitivity persistent showed methicillin sensitive staphylococcus. What is your next step of investigation and managment for this lady ??? Any suggestions ??

This is a classic case when the laboratory results and clinical presentation does not add up. In these cases, disease presentation takes precedence before any laboratory test. If I will manage her case, I would repeat all the work up, especially the culture to ensure that antibiotic sensitivity patterns are accurate and what was isolated was not a mere contaminant. I will also consider the possibility that there is another fever source and I'll do work up to look for other foci of fever. Ano...
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