12-16-2008, 04:00 PM
A 25-year-old woman is hospitalized because of fever and left-sided chest pain of 3 days' duration. The patient has a history of heroin injection drug use; her last injection was the morning of admission. Medical history is otherwise unremarkable.
On physical examination, temperature is 40 °C (104 °F), pulse rate is 120/min, respiration rate is 18/min, and blood pressure is 120/78 mg Hg. Swelling and tenderness are present over the left sternoclavicular joint. Cardiac examination discloses a grade 2/6 systolic murmur that increases in intensity on inspiration. The remainder of the examination is normal. The leukocyte count is 21,000/μL (21 × 109/L).
Aspiration of the left sternoclavicular joint reveals a small amount of purulent material. Blood and fluid from the aspirate are sent for culture.
Pending culture results, which of the following antimicrobial regimens should be initiated?
A Cefazolin
B Cefazolin plus gentamicin
C Vancomycin
D Vancomcyin plus cefepime
] E Vancomycin plus metronidazole plus ceftriaxone
On physical examination, temperature is 40 °C (104 °F), pulse rate is 120/min, respiration rate is 18/min, and blood pressure is 120/78 mg Hg. Swelling and tenderness are present over the left sternoclavicular joint. Cardiac examination discloses a grade 2/6 systolic murmur that increases in intensity on inspiration. The remainder of the examination is normal. The leukocyte count is 21,000/μL (21 × 109/L).
Aspiration of the left sternoclavicular joint reveals a small amount of purulent material. Blood and fluid from the aspirate are sent for culture.
Pending culture results, which of the following antimicrobial regimens should be initiated?
A Cefazolin
B Cefazolin plus gentamicin
C Vancomycin
D Vancomcyin plus cefepime
] E Vancomycin plus metronidazole plus ceftriaxone