A 38-Year-Old Hospitalized Man Is Evaluated for Persistent Fever

A 38-year-old hospitalized man is evaluated for persistent fever.  He has a history of paraplegia after spinal injury and was admitted 2 weeks ago due to septic shock from an infected sacral pressure ulcer.  His condition improved with broad-spectrum antibiotics, intravenous fluids, vasopressors, and wound debridement, but he has been having recurrent fevers for the past 4 days.  The patient also has a history of asthma and takes an inhaled glucocorticoid and bronchodilator.  Temperature is 38.3 C (101 F) , blood pressure is 120/80 mm Hg, and pulse is 96/min.  Several white patches are present on the oral mucosa.  There is a peripherally inserted central venous catheter in the right arm with mild tenderness but no surrounding erythema.  The sacral pressure ulcer has pink granulation tissue with a mild amount of serosanguinous fluid.  A chronic indwelling urinary catheter is draining yellow-colored urine.  Repeat blood cultures grow budding yeasts.  Which of the following is the most likely source of the organism in this patient's blood culture?

A) Central venous catheter
B) Contaminated sample
C) Indwelling urinary catheter
D) Oropharyngeal infection
E) Pressure ulcer

Correct Answer:

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