CONTAMINANT OR DEADLY INFECTION?

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Coagulase-negative staphylococcus (CoNS) is a common harmless skin commensal and often disregarded when isolated in clinical specimens. However, this colonizer can prove to be pathogenic life-threatening CASE PRESENTATION: A 24-year-old obese woman with Grave's disease type 1 diabetes presented altered mental status. She was tachycardic 170, hypothermic 94.6 °F, tachypneic 43 breaths per minute spO2 of 92% requiring BIPAP. Her labs were notable for WBC 31 x 109/L neutrophilic predominance 6% bandemia, anion-gap metabolic acidosis pH 6.8, CO2 26 mmHg, bicarbonate 4 mEq/L, glucose 791 mg/dL, creatinine 1.88 mg/dL. treated septic shock vasopressors, fluids, antibiotics as well diabetic ketoacidosis insulin. required intubation agitation tachypnea the setting severe acidosis. Given her refractory tachycardia, she started on esmolol concern thyrotoxicosis given history Graves' elevated free T4 T3. Propylthiouracil stress dose steroids, but propranolol not vasopressor need. One two blood cultures positive gram cocci clusters, vancomycin started. On hospital day 2, developed fever 104 worsening hypotension increased support. CT abdomen demonstrated vague nodularity thickening along margins pubis left inguinal region. antimicrobials broadened vancomycin, piperacillin-tazobactam, metronidazole, doxycycline fluconazole. exam, had multiple draining ulcerative abscesses purulence over mons fluctuance region that subsequently opened irrigated. also evidence vulvovaginal candidiasis.Her speciated oxacillin susceptible S. Lugdunesis, likely source soft tissue infection mons. extubated weaned off vasopressors. received 7 days IV ampicillin-sulbactam metronidazole transitioned cefadroxil discharge. DISCUSSION: lugdunensis gram-positive, catalase-positive, coagulase-negative coccus associated wide variety infectious presentations. Unlike other CoNS, similar aureus regards its virulence. studies have perineal area. Most suggest nonendocarditis bacteremia less aggressive are nosocomial, though subject selection bias, since CoNS many institutions (1). CONCLUSIONS: Single Lugdunensis should dismissed contaminants considered picture. REFERENCE #1: Hellbacher C, Törnqvist E, Söderquist B. Staphylococcus lugdunensis: spectrum, antibiotic susceptibility, phenotypic genotypic patterns 39 isolates. Clin Microbiol Infect. 2006 Jan;12(1):43-9. doi: 10.1111/j.1469-0691.2005.01296.x. PMID: 16460545. DISCLOSURES: No relevant relationships by Kathleen Doo, source=Web Response Tess Knudson-Fitzpatrick,