Age and Ageing 2018; 0: 1 © The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: firstname.lastname@example.org Clinical Reminder Clinical correlation of blood culture results Conﬂict of interest None declared. A 78-year-old female was treated with ﬂucloxacillin for leg cel- lulitis. This was changed to amoxicillin for a week following 1 1 1 ABHAY KUMAR DAS ,PAUL DODDS ,ELEANOR BRUNT , isolation of Enterococcus faecium in the blood cultures. She had 2 JONATHAN WAREING aortic murmur and changed bowel habit. Four months later, Mid Yorkshire Hospitals NHS Trust—Medicine for the Elderly Leeds Medical School—Faculty of Medicine the GP referred her to a nephrologist for progressive renal Address correspondence to: Abhay Kumar Das, impairment with chronic anaemia. She had weakly positive Mid Yorkshire Hospitals NHS Trust—Medicine for the Elderly, cANCA (PR3 1.8) and negative anti-GBM antibody. She also 22 Peregrine Avenue, Morley, Leeds LS27 8TD, UK. developed progressive thrombocytopenia and CRP remained Tel: +44-1924-816140; Fax: +44-1924-816136. Email: email@example.com elevated. She was re-admitted from haematology clinic for evaluation. The blood culture again isolated E. faecium which remained sensitive to amoxicillin. She died from a cardiac arrest the same day. Post-mortem revealed aortic valve endocarditis. References Enterococci are more prevalent in older patients with 1. Dhawan V. Infective endocarditis in elderly patients. Current infective endocarditis . Glomerulonephritis is common in infectious disease reports. Curr Infect Dis Rep 2003; 5: bacterial endocarditis and prolonged inﬂammatory activity 285–92. may lead to positive cANCA . Prolonged guided anti- 2. Ghosh GC, Sharma B, Katageri B et al. ANCA positivity in biotic therapy, of up to 6 weeks duration, is recommended a patient with infective endocarditis-associated glomerulo- for the successful treatment of bacterial endocarditis . nephritis: a diagnostic dilemma. Yale J Biol Med 2014; 87: 373–7. 3. Habib G, Lancellotti P, Antunes M et al. ESC Guidelines Key points for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the � Signiﬁcance of blood culture result. European Society of Cardiology. Eur Heart J 2015; 36: � Use of appropriate antibiotic. 3075–128. � Consider bacterial endocarditis. � Longer duration of treatment for endocarditis. doi: 10.1093/ageing/afy063 Downloaded from https://academic.oup.com/ageing/advance-article-abstract/doi/10.1093/ageing/afy063/4985484 by Ed 'DeepDyve' Gillespie user on 08 June 2018
Age and Ageing – Oxford University Press
Published: Apr 25, 2018
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