Age: 49.0
Sex: M
Vaccine: COVID19
Symptoms: Hepatic cirrhosis, Incisional drainage, Joint arthroplasty, Leukocytosis, Peritoneal fluid analysis abnormal
Clinical narrative: Patient is a 52 y.o. male known history of cirrhosis of liver with ascites, acute on chronic anemia, hypertension, left knee TKR 6 who presented from home on 9/19/2023 with left knee pain and shortness of breath and found left prosthetic knee infection complicated by sepsis due to prosthetic joint infection as well as streptococcal bacteremia and COVID-19.  Patient was followed by hepatologist for decompensated cirrhosis of liver with ascites required 3 times abdominal paracentesis and also found SBP.  Patient followed by infectious disease specialist for prosthetic joint infection with streptococcal bacteremia and given IV Rocephin and continue for 6 weeks.  Hepatologist recommended to restart oral Cipro once completed IV Rocephin as outpatient for SBP.  Patient needs follow-up ID, hepatologist as outpatient.    Left Prosthetic Knee infection Sepsis due to prosthetic joint infection and bacteremia and COVID-19 present on admission: -ID and ortho following. S/p arthrodesis 9/20. Fluid c/w infection with more than 50,000 WBC, culture negative patient had 1 set of blood culture with strep mutans on admission -S/p I&D with TKA explant and antibiotic spacer placement 9/22 with Dr. -Continue IV antibiotics per ID on Rocephin. Surgical cultures with no growth. ID now signed off with PICC line placed for IV Rocephin 2 g every 24 hours for total of 6 weeks with stop date 11/3/2023 and maintain IV until ID follow-up with weekly CBC with differential, CMP, ESR, CRP faxed and follow-up ID CNP on 11/2/2023 at 12 PM   Streptococcal bacteremia   -1/2 blood cultures growing strep viridans. -Secondary to prosthetic joint infection -ID as above rocephin IV for 6 weeks.  Repeat blood cx 9/22 NGTD  Covid-19 infection   -He was found to be positive on admission -Evaluated by ID.  Patient was given on Remdesivir for 5 days and completed.  -Patient was given IV decadron X 5 DAYS and will discontinue due to leukocytosis.  -has been vaccinated but has not received booster -Continue isolation at present for total of 10 days   Decompensated cirrhosis with ascites   -Known cirrhosis with ascites s/p paracentesis last week. Noted to have reaccumulation on exam and imaging -Repeat paracentesis done 9/21 with removal of 7L fluid. Cultures not sent and fluid no longer available -Hepatology consulted. He will need repeat EGD in 4 weeks. Resume cipro SBP prophylaxis once he completes antibiotics for current infection -Hepatologist increased bumex to bid as well as spironolactone increased to twice daily on 9/25.. Cont thiamine and folate.  -Repeat US with moderate to large ascites and repeat paracentesis completed with 2.1 L fluid removed and finding consistent with SBP with ascitic fluid study including cell count  -Hepatologist recommending repeat another paracentesis on 9/27  -Received IV albumin.  -Continue increase diuretic regimen per hepatologist, follow-up liver clinic already scheduled.  -Avoid narcotics as well as benzodiazepine -Can use Tylenol up to 2 g/day for pain.  -Follow-up hepatology clinic   Acute on chronic anemia   -acute on chronic -relatively stable compared to baseline. Cont to monitor post op   Hypertension  -Continue on increased coreg dose for now