When Antibiotics Appear to Fail

he patient was a 17-year-old unmarried, primi-gravida who delivered via vacuum-assisted vaginal extraction two days previously. In the course of the delivery, a significant midline and extensive right lateral wall vaginal tear occurred. The patient was discharged on the first postpartum day; however, she represented herself to the clinic 24 h later with shaking chills, a temperature of 103.3F, and bilaterally costovertebral angle (CVA) tenderness. The patient denied any dysuria, vomiting , episiotomy pain, abdominal pain, foul smelling discharge, or breast tenderness. Physical examination revealed a temperature of 103.3F, pulse 110, respirations 16, blood pressure 110/70. Pertinent physical findings were limited to the abdominal and pelvic examinations. The abdomen was soft and nontender. No masses were present. Bowel sounds were present. The fundus was firm, 3 cm below the umbilicus, and nontender.