Bacteremia: A noble source
Singh Z, and Gunderson H. Bacteremia: A noble source. J Gen Intern Med 2017; 32(2):S454
Journal of General Internal Medicine
LEARNING OBJECTIVE #1: Recognize unusual sources of bacteremia LEARNING OBJECTIVE #2: Educate patients on the use of insulin needles CASE: 57 year old African American male with a PMHx of well-controlled Type-2 DM, on Lantus, presented to the hospital with fevers, chills, and lethargy with abdominal pain and nausea for 2 days duration. He stated that he was in overall good health and denied any sick contacts, cough, sputum production, chest pain, palpitations or shortness of breath. Physical examination was essentially unremarkable except for a group of small painless and pruritic excoriations along the lower half of his abdomen. They were 1-2 mm in size, red in color, and slightly raised, patient stated that they had been there for a little more than 2 weeks. Patient was found to have a temperature of 39.4 deg C, and a heart rate of 115, with a leukocytosis of 17,000. He was admitted for further septic workup. Subsequent blood cultures were positive for MRSA on 2 bottles and he was started on IV antibiotics for bacteremia without any obvious source. Echo was negative for endocarditis. On further questioning, patient stated that he had a remote history of IV drug abuse but quit over 15 years ago and he denied any recent use. He denied any cuts or bruises on his body, and denied recent dental procedures. When asked about his excoriations on his abdomen, he stated that is the location of his insulin shots. Upon further questioning about his insulin needles it was found that the patient was reusing them to inject himself because he was unable to afford more. It was deemed that his insulin needles were the source of his bacteremia. Patient then completed treatment for MRSA bacteremia and his labs improved and he was discharged home. IMPACT: Most cases of bacteremia we see in Detroit are from IV drug abusers or skin and soft tissue infections. In this case, this gentleman was unable to afford new needles and tried to save costs by reusing the old supplies he already had in order to continue to receive his medication. It really changed my thinking because there are many other sources of bacteremia which us physicians usually do not think about right away that may potentially lead to detrimental effects on the human body. DISCUSSION: IV drug abuse is a major worldwide epidemic that affects hundreds of thousands of people and their families. Working in downtown Detroit, we encounter many patients on a daily basis who come in with bacteremia and develop endocarditis or other devastating diseases causing them to be bed bound for the rest of their lives. Physicians have to realize that there are many otherways of becoming bacteremic other than IVdrug users. We also need to learn the cost effectiveness of our therapies. Diabetic supplies can be very expensive for some patients and we need to realize the consequences of this. We should also take time to educate out patients and explain the detrimental effects of reusing medical supplies that are only meant for a single use.