22nd May 2024

A 74-year-old male is referred to the acute medical unit by his GP with lethargy and fever. He had felt lethargic for 3-4 days

A 74-year-old male is referred to the acute medical unit by his GP with lethargy and fever. He had felt lethargic for 3-4 days and complained of some left shoulder pain and back pain. He had rigors, but nil else in terms of positive symptomatology.  He weighs 83 kg, has a history of Type 2 diabetes and benign prostatic hypertrophy. He has been moved to a level 2 unit as he requires vasopressors to support his blood pressure. A CT demonstrates fluid around his left shoulder joint, suspicious of a collection. The clinical team feel that his shoulder collection is the most likely source of his sepsis. His CRP is falling, having been on antibiotics for 2 days, now 345 from 440 mg/dL. His WCC are 22 from 25 x 10⁹/L. His Hb is 74 g/L, having fallen from 98 g/L on admission.

What is the most appropriate next step?

Select the SINGLE most appropriate option from the list below. Select ONE option only.