It was reported that the patient with known left ventricular assist device (lvad) infection was having elevated lactate dehydrogenase (ldh) levels and tea colored urine.The patient was on heparin and integrilin (eptifibatide) drips.The log files contained a few pulsatility index (pi) events and routine power source changes.Additional information was received that abdominal, pelvis, and thorax computed tomography (ct) results showed that there was no acute intra-abdominal pathologic process identified.Specifically, no evidence of suspicious intra-abdominal fluid collection, ascites, hemoperitoneum or retroperitoneal bleed was found; there was a minimally distended urinary bladder with mild scattered bowel gas; there were two cholelithiasis with innumerable punctate dependent cholelithiasis, no gallbladder distention or inflammatory changes, and there was an interval development small greater left pleural effusions with basilar compressive atelectasis.Peripheral blood cultures were done on (b)(6) 2022 was positive for enterococcus faecalis and it was being treated with ampicillin, penicillin, vancomycin, daptomycin, zyvox (linezolid).Cultures from another hospital also showed vancomycin susceptible enterococcus faecalis via polymerase chain reaction (pcr).Cultures done on (b)(6) 2022 were negative to date and the computed tomography (ct) of the abdomen and pelvis were without clear evidence suggestive of the left ventricular assist device (lvad) involvement.On (b)(6) 2022, abdominal ultrasonogram without evidence of vegetation along the driveline.Also, on (b)(6) 2022, a transesophageal echocardiogram (tee) showed no evidence of vegetations on valves or along visualized portions of implantable cardioverter defibrillator (icd) lead.A positron emission tomography - computed tomography (pet-ct) done on (b)(6) 2022 was suggestive of lvad infection.Cardio thoracic surgery (cts) was consulted regarding re-implant but the patient was too high of a surgical risk.The patient was to continue iv rocephin (ceftriaxone) 2 gram (gm) every 12 hrs and iv ampicillin 2 gm every 8hrs (dose adjusted for renal function) and both medications were planned for 8 weeks course after the negative blood cultures.Infectious diseases was consulted and recommended iv antibiotics through 18jul2022 and then to transition to amoxicillin 500mg twice a day in addition to oral doxycycline.
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