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Question: ID

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You are seeing a 5 year old child with cochlear implants placed 8 months ago. The child has fever, headache, vomiting, altered mental status, and meningismus. The implant sites are well healed and show no signs of local infection.

Which is the most likely organism encountered in his cerebrospinal fluid?

pemsou5_wp • May 15, 2018

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  1. Kelly May 15, 2018 - 4:09 pm Reply

    D. Streptococcus pneumoniae. Children with cochlear implants have an increased risk of bacterial meningitis, and cases have been reported as soon as 24 hours after implant placement up to several years after placement. If it has been > 2 months since implant placement, empiric antibiotic therapy is the same as patients without implants: vancomycin + third generation cephalosporin. If within 2 months of implant placement, additional coverage for gram negative organisms such as Acinetobacter and Enterococcus as well as Staph aureus is needed: uptodate suggests vancomycin + meropenem.

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