A 68-year-old male with poorly controlled diabetes and newly diagnosed end-stage renal disease presents to the ER with the complaint of “positive blood cultures.” The patient was sent to the ER from his dialysis facility and is accompanied by the blood culture results drawn 48 hours earlier, as well as routine labs drawn today at dialysis. The cultures were drawn because the patient experienced chills without documented fever toward the end of his dialysis run two days ago. 

He currently denies any infectious symptoms including headache, sinus pain/pressure, otalgia, rhinorrhea, pharyngitis, neck stiffness, lymphadenopathy, chest congestion or cough, nausea, vomiting, diarrhea, abdominal pain, flank pain, skin rash, joint pain/swelling, or myalgias. 

He denies any ill exposures or recent injury. He does not endorse chills or subjective fevers since his previous dialysis run two days ago. Today’s run was uneventful. He also has no pain, swelling, or drainage at the site of his dialysis access catheter in the right subclavian position. The catheter was placed about 10-14 days ago to initiate hemodialysis.

On examination, T 98.7, HR 68 and regular, BP 130/76, R 16 and non-labored, Pox 98% on RA. He appears generally comfortable. Detailed comprehensive physical examination is unrevealing. 

The blood cultures (1 set drawn from the dialysis access catheter, 1 set drawn peripherally) both demonstrate coagulase-negative gram-positive cocci in chains. Final identification and antibiotic sensitivities are pending. 

Labs drawn at dialysis today show WBC 8,000 with normal differential, Hgb 11.4 (stable) with normal indices, platelets 247,000. Chem 7 is unremarkable except for creatinine of 5.2. The patient is anuric. CXR performed in the ER shows no evidence of infiltrate. 

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