Bobde Rajanish, Berger Joseph I, Jalil Urma, Kalaydjian Garine
Infectious Disease, St. John's Riverside Hospital, Yonkers, USA.
Internal Medicine, St. John's Riverside Hospital, Yonkers, USA.
Cureus. 2022 Jan 19;14(1):e21432. doi: 10.7759/cureus.21432. eCollection 2022 Jan.
We present a 62-year-old woman with a history of uterine cancer status post-total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) on paclitaxel, who presented to the emergency department febrile at 101.7 Fahrenheit and complaining of fatigue and urinary incontinence. Laboratory testing revealed neutropenia and urinalysis showed elevated bacteria with minimal white blood cells, and negative leukocyte and negative nitrites. Urine cultures ultimately showed with negative blood cultures. is a less frequently speciated Staphylococcus and has been increasingly found due to advances in identification using matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS). are Gram-positive cocci, nonsporulating, nonmotile, facultatively anaerobic, catalase-positive, coagulase-negative, oxidase-negative, delta-hemolytic organism. Traditionally, it is seen in skin and soft-tissue infections, as well as vascular infections, however, has minimal occurrences in urinary tract infections. The risk of infection is increased in immunocompromised states and empiric treatment is warranted while waiting for definitive results. Our patient was started on cefepime, valacyclovir, fluconazole, and a single dose of vancomycin while in the emergency department. Worsening thrombocytopenia during her antibiotic course necessitated the re-evaluation of antibiotic agents which can cause thrombocytopenia. Subsequently, due to the patient's improved clinical status, and low risk of severe outcome, fluconazole and valacyclovir were discontinued, and cefepime was changed to ceftriaxone.
我们报告一名62岁女性，有子宫癌病史，接受了全腹子宫切除术和双侧输卵管卵巢切除术（TAH-BSO），正在接受紫杉醇治疗，她因发热至华氏101.7度前往急诊科就诊，主诉疲劳和尿失禁。实验室检查显示中性粒细胞减少，尿液分析显示细菌增多，白细胞极少，白细胞酯酶阴性，亚硝酸盐阴性。尿液培养最终显示血培养阴性。是一种较少见的葡萄球菌，由于基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）鉴定技术的进步，其发现率越来越高。是革兰氏阳性球菌，不产芽孢，无运动性，兼性厌氧，过氧化氢酶阳性，凝固酶阴性，氧化酶阴性，δ溶血菌。传统上，它见于皮肤和软组织感染以及血管感染，然而，在尿路感染中极少发生。免疫功能低下状态下感染风险增加，在等待明确结果时应进行经验性治疗。我们的患者在急诊科时开始使用头孢吡肟、伐昔洛韦、氟康唑和单剂量万古霉素。在她的抗生素疗程中血小板减少症恶化，因此需要重新评估可能导致血小板减少症的抗生素药物。随后，由于患者临床状况改善，严重后果风险较低，停用了氟康唑和伐昔洛韦，将头孢吡肟改为头孢曲松。
