Age: 80.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Debridement, Device related infection, Incision site pain, Medical device change, Postoperative abscess
Clinical narrative: Hospitalized;  COVID-19 positive (9.13.21);  fully vaccinated.  Admission Date: 8/27/2021 Discharge Date: 9/15/2021  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Surgical wound infection  Post-operative wound abscess  Incisional pain    HOSPITAL COURSE: Patient is an 81 year old male with a PMHx significant for asthma, hypertension, type 2 diabetes, hyperlipidemia who presented on 08/27/2021 with a left femur periprosthetic infection.  He initially went an intramedullary nail in November of 2020 for a left intertrochanteric femur fracture.  He presented on 08/24/2021 where he underwent an operative irrigation and debridement with exchange intramedullary nailing with an antibiotic coated nail.  He continued to have copious drainage through his previous incisions while at his nursing home, and a CT image demonstrated a deep thigh abscess superficial to the iliotibial band.  He had been started on ceftriaxone 2 g daily for a course of 6 weeks during his previous admission.  Due to the drainage in need for repeat irrigation and debridement, he was admitted to Orthopedic on 08/27/2021.   On 08/30/2021, he underwent irrigation debridement of his left thigh wound with wound VAC placement.  Copious purulent drainage was noted at the time.  He underwent a left lower extremity I and D with wound VAC application 09/02/2021, where again purulence drainage was noted and a sinus tract between his lateral and anterior incisions deep to the fascia was noted.  He underwent an irrigation debridement of his left thigh wound with implantation of absorbable antibiotic beads and application of an incisional wound VAC on 09/07/2021.  At this time, there was no additional purulent drainage noted and the underlying tissue appeared healthy and viable.  His incisional wound VAC remained in place for 3 days and then it was removed at the bedside.  He continued to have serosanguineous drainage on dressings overlying the incision on his lateral thigh that slowed down gradually over period of several days.  Infectious Disease was reengaged during his most recent hospitalization, and they have recommended he continue on 2 g Rocephin for 6 weeks from his most recent I&D, (09/07/2021) followed by 3-6 months of suppressive amoxicillin.  Intraoperative tissue cultures collected on his I&D's performed on 08/30/2021 and 09/02/2021 all came back negative.  He did have a COVID swab performed prior to discharge on 09/13/2021, which was positive.  He was placed in respiratory isolation.  He was completely asymptomatic.  He had 2 additional COVID tests performed on 09/14 and 9/15 which were negative.  He was discharged to his skilled nursing facility in stable condition, tolerating a general diet.  He is to remain nonweightbearing in his left lower extremity until he follows up in clinic with Dr.  He had a PICC line placed in his right upper extremity prior to discharge and should receive 6 weeks of IV antibiotics from his most recent I and D followed by 3 6 months of amoxicillin, as per Infectious Disease recommendations.