Reference no: EM133695313
Question
A 35 year-old female who is status-post heart surgery 12 years ago is admitted on 6/1 for elective Percutaneous Endoscopic Gastrostomy (PEG) tube placement. His medical history is significant for end-stage renal disease (ESRD), respiratory failure due to Covid-19 infection resulting in a tracheostomy and is ventilator dependent, hemodialysis three times per week, and HTN. He has a Foley catheter draining amber colored urine. On 6/2, patient was taken to the OR for elective placement of PEG tube, which was tolerated well, Left IJ catheter was inserted. He was transferred to the surgical unit due to his ventilator needs. Temperature was 37 C, PEG site oozing serosanguinous drainage, stool specimen collected for abdominal pain and diarrhea, same positive for C. diff, metronidazole started. On 6/4, temperature recorded as 38.3 C, PEG site clean dry, culture send for blood, sputum and urine. On 6/5, Urinalysis reported 3+ leukocytes esterase, WBC 11,000, and moderate bacteria. On 6/6, urine culture positive for 60,000 CFU/ml gram-negative bacilli identified as Providencia stuartii, blood culture negative. Patient developed watery stools, c/0 abdominal pain, and increase in WBC from 11,000 to 27,000. Later on, 6/9, temperature was 38.8 C, blood culture was repeated. On 6/10, blood culture.