A 52-Year-Old Man Is Brought to the Emergency Department Due

question 193

Multiple Choice

A 52-year-old man is brought to the emergency department due to worsening right leg pain, fever, and confusion.  The patient injured his leg while operating a motorized watercraft on the ocean near Florida 2 days ago.  Temperature is 38.9 C (102 F) , blood pressure is 90/50 mm Hg, and pulse is 120/min.  The patient is lethargic and diaphoretic.  Physical examination reveals a small laceration on the dorsum of the right foot with surrounding edema, erythema, and several hemorrhagic bullae.  Leukocyte count and serum lactic acid levels are elevated.  Intravenous fluids and empiric antibiotics are administered, and surgical debridement of the wound is performed.  Blood and wound cultures yield curved gram-negative rods.  Which of the following is the greatest risk factor for this patient's infection?

• A)Bacterial nasal colonization
• B)Condition causing iron overload
• C)Exposure to infected rodent urine
• D)Lack of booster immunization
• E)Recent broad-spectrum antibiotic use