22nd June 2021

A 30-year-old lady presents with a fever and a tender bulky uterus 4 days after delivering her second child

A 30-year-old lady presents with a fever and a tender bulky uterus 4 days after delivering her second child, via caesarean section. She looks lethargic and diaphoretic, with a blood pressure of 90/65mmHg, heart rate of 120 beats per minute, respiratory rate of 24 breaths per minute and a temperature of 39.0 degrees Celsius. Empiric antimicrobial therapy and fluid resuscitation is initiated. Early growth from blood cultures are indicative of a group A streptococcus. Over the course of the next day, the patient remains febrile, tachycardic and hypotensive, although her blood pressure is fluid responsive.

Select the SINGLE most appropriate option in managing this patient with puerperal pyrexia. Select ONE option only.