A 45-year-old female who underwent bilateral lung transplantation 6 days ago is brought to the ICU..

A 45-year-old female who underwent bilateral lung transplantation 6 days ago is brought to the ICU intubated following a seizure episode. Her transplantation was uneventful and she was transferred to a regular nursing floor on postoperative day 4. She was intubated at bedside for airway protection and brought to the ICU. On examination, the patient is sedated and her pupils were mildly dilated but equally reactive to light. Her blood pressure was 110/90 mm Hg and heart rate 120 beats per minute. Mild purulence is noted from the lower part of sternotomy site with no obvious instability or bony

A 45-year-old female who underwent bilateral lung transplantation 6 days ago is brought to the ICU intubated following a seizure episode. Her transplantation was uneventful and she was transferred to a regular nursing floor on postoperative day 4. She was intubated at bedside for airway protection and brought to the ICU. On examination, the patient is sedated and her pupils were mildly dilated but equally reactive to light. Her blood pressure was 110/90 mm Hg and heart rate 120 beats per minute. Mild purulence is noted from the lower part of sternotomy site with no obvious instability or bony crepitations. The output from her chest drains was nonpurulent. An arterial blood gas shows an elevated lactate of 2.5 mmol/L, partial pressure of oxygen of 92 mm Hg, and partial pressure of carbon dioxide of 38 mm Hg. Her laboratory results demonstrate a WBC count of 16 500 cells/L, hemoglobin of 9.1 g/dL, platelet count of 350 000/L. Blood cultures are collected. Wound cultures sent from the regular nursing floor prior to transfer show numerous neutrophils but a negative gram stain. A CT scan of the brain did not show any acute abnormalities. Debridement of sternal wound is done and the patient is started on empiric vancomycin and piperacillin-tazobactam. What is the NEXT BEST step in the management of this patient? A. Wait for final culture results, no additional antibiotics B. Lumbar puncture, empirical IV acyclovir to treat Herpes simplex encephalitis C. Check serum ammonia level; start IV doxycycline to cover Mycoplasma hominis D. Start IV micafungin for empiric fungal coverage E. Order an MRI of the brain to rule out posterior reversible leukoencephalopathy

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