MKSAP: 52-year-old man with fatigue and fever

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is admitted to the hospital with fatigue and fever of 3 days’ duration. He is a health care worker and has a bicuspid aortic valve. He takes no medications. Blood cultures are obtained at the time of admission, and he is started on empiric vancomycin for possible endocarditis. On hospital day 2, his initial blood cultures become positive for gram-positive cocci in clusters, and on hospital day 3, his blood cultures grow methicillin-resistant Staphylococcus aureus. Susceptibility to vancomycin is intermediate (MIC = 4 µg/mL). On hospital day 4, the patient continues to appear ill. Temperature is 38.6 °C (101.5 °F), blood pressure is 105/65 mm Hg, and pulse rate is 110/min. On cardiopulmonary examination, the lungs are clear, and a grade 2/6 systolic ejection murmur is heard at the right upper sternal border, but there is no evidence of heart failure or septic emboli. Which of the following is the most appropriate management? A: Discontinue vancomycin and begin daptomycin B: Discontinue vancomycin and begin linezolid C: Discontinue vancomycin and begin trimethoprim-sulfamethoxazole D: Increase vancomycin dose Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Family Physicians Tags: Conditions Infectious disease Source Type: blogs