Question
A 60-year-old female presents to the emergency department complaining of fever and fatigue that started three days ago. The fever is associated with occasional chills. She has a past medical history of diabetes type 1 for which she takes insulin and chronic kidney disease. She is on hemodialysis through a right subclavian vein catheter. She has never had similar symptoms before. On examination, temperature is 39 C, blood pressure is 140/85 mmHg, pulse is 91 beats/min, and respiratory rate is 18 breaths/min. There is erythema, swelling, and tenderness over the skin around the right subclavian vein catheter insertion site. Abdominal, cardiovascular, and neurological examinations were within normal limits. Laboratory tests revealed a hemoglobin level of 10g/dL, a WBC count of 12,000/mm3, and platelets of 200,000.mm3. Blood cultures were drawn and sent for gram stain and culture, the right subclavian vein catheter was removed, and the patient was started on intravenous empiric antibiotics. Two separate blood cultures showed growth of staphylococcus aureus that is sensitive to the empiric antibiotic administered. Four days later, the patient is afebrile and is feeling much better. Two blood cultures reveal no organism growth. Which of the following is the best next step in the management of this patient?
| A. | Echocardiogram |
| B. |
Re-insert subclavian vein catheter and discharge patient on four weeks of antibiotic therapy |
| C. |
CT angiogram of the right subclavian vein |
| D. |
Consult nephrology |
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