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Follow-up blood cultures positive

A 2 month old was seen in the ED 36 hours ago with a temperature of 39.2. The CBC had a WBC of 11.2 with 70% lymphocytes and no bandemia. Urinalysis was negative. The lab calls you to report that 1 of 2 blood culture bottles is growing gram positive cocci in clusters. You call the patient and the parent reports that he is doing well, is now thought to be afebrile (tactile, parents have not checked the temperature in 24 hours), and is feeding well. What do you do?

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2mo old +Bcx GPC clusters on follow-up - what do you do?

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pemsou5_wp • September 29, 2017

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  1. Kelly September 30, 2017 - 3:11 pm Reply

    One of our faculty asked for the “right answer”. My response: the conundrums aren’t meant to have a “right” answer – they are meant to see the range of what people do. I should make that clearer! But, that being said, I’ll take all the ID based conundrums and ask them of our peds ID specialist during our upcoming “Ask an ID specialist” fellow conference.

    Personally, I voted for redraw cultures, give ceftriaxone, f/u next day, but I could also see E because the likelihood of it being a real bacteremia is super low. I guess I feel if I’m bringing them in to redraw the blood cultures, I might as well give some ceftriaxone. Although one could argue there are risks to any medication, especially parenteral.

    Would love to hear others’ thoughts and rationale.

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