01-26-2009, 08:51 PM
A 50-year-old patient with COPD is in the intensive care unit (ICU) recovering from an acute exacerbation of chronic bronchitis that required intubation and intravenous steroids. He improves gradually and is weaned from mechanical ventilation by day three of his intensive care unit stay, though he continues to have low-grade fever. On day 4, however, the medical student assigned to his case finds that the patient has a cool, pulseless left leg on morning rounds. The lack of pulses is confirmed by Doppler study, and vascular surgery is consulted. The patient is brought immediately to the operating room and an emergent thrombectomy of the left femoral artery is performed. Histopathologic examination of the thrombectomy specimen shows hyphae, pseudohyphae, and yeast forms. Blood cultures, drawn from the evening before and the day of the surgery, grow similar organisms, consistent with Candida species. Bacterial blood cultures are negative. A bedside transesophageal echocardiogram is performed that shows a 2-cm vegetation on the aortic valve. Amphotericin B therapy is initiated. Which of the following is an additional appropriate therapy for this patient™s presumed endocarditis?
A. Ampicillin and gentamicin
B. No additional therapy, 6-8 weeks of amphotericin
C. Oral ketoconazole
D. Surgery
E. Vancomycin
A. Ampicillin and gentamicin
B. No additional therapy, 6-8 weeks of amphotericin
C. Oral ketoconazole
D. Surgery
E. Vancomycin