SHM Converge Scientific Abstract ePoster Gallery-Bifidobacterium as a Rare Cause of Prosthetic Joint Infection in an Immunocompetent Host

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This case describes a 45-year-old woman with ischemic cardiomyopathy, CKD stage 3b, and a recent history of MRSA bacteremia who presented with shortness of breath and chest pain. She was diagnosed with acute heart failure exacerbation and treated with IV diuretics, but her creatinine worsened and a blood culture grew gram-positive cocci in clusters. Vancomycin was started and an acute kidney injury workup was initiated. Because of worsening renal function and concern for recurrent MRSA bacteremia, she was transferred to a referral center for transesophageal echocardiography (TEE) to evaluate for infective endocarditis.<br /><br />At the receiving hospital, vancomycin was restarted and nephrology was consulted. TEE was negative for endocarditis. Shortly afterward, outside records revealed the blood culture was actually methicillin-resistant Staphylococcus epidermidis, present in only 1 of 4 bottles, suggesting contamination rather than true bacteremia. This result had been available before transfer but was not communicated. Vancomycin was stopped, nephrology determined the renal injury was likely cardiorenal syndrome, and her home bumetanide was resumed. Her kidney function improved after vancomycin was discontinued, and she was discharged home within 72 hours.<br /><br />The presentation highlights how telehealth and interhospital transfers, while useful, can contribute to delays, miscommunication, longer length of stay, higher costs, and potentially unnecessary treatment in complex patients. It also emphasizes telehealth limitations, including reduced physical examination, greater reliance on patient self-report, and increased risk of diagnostic error. The authors conclude that hospitals should carefully assess whether patients can be safely managed locally before transfer and that better systems are needed to improve communication and safety during care transitions.

Asset Subtitle

David W. Walsh

Meta Tag

Author List David W. Walsh, Jackson Elam, Lissete Whitaker, Natalie Caylor

Category Clinical Vignettes

Concept Blood Culture

Concept Hospital Transfer

Concept Telehealth

Concept Acute Kidney Injury

Concept Coagulase-Negative Staphylococci

Distinguished Non-Finalist

Presenter Organization dawalsh@augusta.edu

Presenting Author David W. Walsh

Track Adult

Keywords

ischemic cardiomyopathy

chronic kidney disease

MRSA bacteremia

acute heart failure

vancomycin

acute kidney injury

transesophageal echocardiography

infective endocarditis

cardiorenal syndrome

telehealth communication

Blood Culture

Hospital Transfer

Telehealth

Acute Kidney Injury

Coagulase-Negative Staphylococci