A 62-year old African-American man presents with fever to 1020F and sweats of 2 days duration. He says that his left internal jugular tunnelled catheter has been “problematic” -- requiring thrombolytic therapy at the past 2 dialysis treatments. He has had some pain in and around the tunneled catheter along with fever approximately 2 months ago and had been treated with vancomycin for 2 weeks. For approximately 3 weeks he has had some neck pain. Physical Examination reveals an ill looking man, blood pressure 96/60 mmHg, heart rate 118 beats per minute, temperature 39.60C. He has splinter hemorrhages in his nail beds (see pic). There is swelling and point tenderness over his lower cervical spine. His JVP is 8 cm, lungs are clear, heart examination shows 2/6 systolic murmur. The rest of examination was negative. The patient’s white blood count is 16.3 x 109/L with a left shift, hematocrit is 31%, potassium is 5.4 mEq/L, BUN 92 mg/dL, creatinine 9.8 mg/dL. Peripheral blood cultures drawn in the emergency department show a methicillin-sensitive staph aureus (MSSA) growing in 4 of 4 bottles. Results from catheter drawn cultures are pending. A bone scan is done and the picture is shown below:
Which one of the following statements is FALSE?
–A.) The patient should be switched from vancomycin to naficillin
–B.) The tunnelled catheter should be removed immediately
–C.) A transthoracic cardiac echo, and if negative a transesophageal echo, should be ordered since it is very likely that the patient has endocarditis
–D.) A neurosurgery consultation should be sought immediately
–E.) This patient should be treated with linezolid
