5. None of the above

Urinary tract infections and pneumonia are two very frequent causes of fever. Prostatitis can occur acutely or chronically and may be a source of fever. However, the patient really has no symptoms pointing to any of these as a source of fever. Furthermore, his physical exam, chest x-ray shows, and urinanalysis show no focal abnormalities suggesting any of these as a source of infection.

The ER staff had placed a Foley catheter and administered ceftriaxone and ciprofloxacin for a presumed urinary tract infection. They had also administered three liters of intravenous 0.9% saline, but the patient’s blood pressure fell to 87/41 mmHg.

We transferred the patient to the ICU, continued intravenous hydration and electrolyte replacement, and changed the antibiotics to pipericillin/tazobactam plus vancomycin, and discontinued his Foley catheter.

What is the best next step to obtain a diagnosis in this patient?

  1. Blood cultures
  2. Bronchoscopy with bronchoalveolar lavage
  3. Chest, abdominal and pelvic CT scan
  4. Obtain additional history and a more thorough physical examination
  5. Urine culture

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