The Real-World Boards: Question #45
Fevers after a long ICU stay.
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A 76-year-old woman was admitted with septic shock due to perforated diverticulitis. She underwent emergent laparotomy and hemicolectomy, after which she was transferred to the ICU, where she was mechanically ventilated for nine days. She remains unable to take adequate nutrition enterally and has a central venous catheter in place for parenteral nutrition.
It is now hospital day 12. She has had intermittent fevers for most of the past five days. She has received piperacillin-tazobactam since admission. Blood, urine, and sputum cultures have been negative.
In the past hour, she has become hypotensive, and vasopressors are begun.