CHIEF COMPLAINT: bacteremia

PRESENT ILLNESS: Mr. [**Known lastname **] is a 47 year old male with End Stage Renal Disease
secondary to  hypertension, who was admitted to [**Hospital1 498**] [**Hospital1 1559**]
with an infected right groin hemodialysis line on [**2156-7-31**].  He
has had multiple access procedures, and the most recent
hemodialysis line was placed approximately two months ago by
[**Hospital1 18**] AV care. Due to his known central stenosis, a groin site
was chosen. For approximately one week, he has been having
yellow discharge around the catheter. He had HD on Friday, at
which time he had a temperature of 101 and yellow discharge.
Upon admission to [**Hospital1 498**], blood and wound cultures were obtained,
which grew Staph Aureus.  He was started on vancomycin, and the
catheter was removed.  He was transferred to [**Hospital1 18**] with
bacteremia from infected hemodialysis line for continued
management.

MEDICAL HISTORY: Endocarditis, Mitral Regurgitation, Hypertension, asthma,
anemia, restless leg syndrome, ESRD/HD, Gastric Esophageal
Reflux Disease, multiple AV grafts bilateral upper extremities,
bilateral nephrectomies for renal carcinoma, s/p bilateral
parathyroidectomy

MEDICATION ON ADMISSION: Meds on [**Hospital1 498**] transfer: ventolin 60mg daily, asa 81mg daily,
sinemet 25/250 2
tabs qhs, benadryl 25mg TID, colace 100mg [**Hospital1 **], labetalol 300mg
[**Hospital1 **],
sevelamer 4000mg TID, Vancomycin 1g daily, verapamil 480mg daily

ALLERGIES: Iron

PHYSICAL EXAM: Vitals: T 98.1, HR 81 a-fib, BP 100/62, RR 20, O2 94RA
Gen: awake/alert/oriented, no acute distress
CV: iregular rate and rhythm, no murmur
Resp: cta bilaterally, decreased in bases
Abd: soft, NT, ND, +BS
Extr:  AV grafts bilateral upper extremities, thrombosed;
palpable radial and pt/dp pulses; left groin catheter site
clean/dry/intact, no erythema/induration

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Currently incarcerated.
History of cocaine use.
No alcohol or tobacco
Other and unspecified infection due to central venous catheter,Acute and subacute bacterial endocarditis,Methicillin resistant Staphylococcus aureus septicemia,End stage renal disease,Abscess of lung,Severe sepsis,Acute respiratory failure,Pneumonia due to other Streptococcus,Cardiogenic shock,Cardiac tamponade,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Intestinal infection due to Clostridium difficile,Acute pericarditis, unspecified,Cardiac complications, not elsewhere classified,Atrioventricular block, complete,Hemorrhage complicating a procedure,Pressure ulcer, stage III,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Acquired absence of kidney,Other iatrogenic hypotension,Personal history of malignant neoplasm of kidney,Atrial fibrillation
Oth/uns inf-cen ven cath,Ac/subac bact endocard,MRSA septicemia,End stage renal disease,Abscess of lung,Severe sepsis,Acute respiratry failure,Pneumonia oth strep,Cardiogenic shock,Cardiac tamponade,Hyp kid NOS w cr kid V,Int inf clstrdium dfcile,Acute pericarditis NOS,Surg compl-heart,Atriovent block complete,Hemorrhage complic proc,Pressure ulcer,stage III,Abn react-renal dialysis,Acquired absence kidney,Iatrogenc hypotnsion NEC,Hx of kidney malignancy,Atrial fibrillation
Admission Date:  [**2156-8-1**]              Discharge Date:   [**2156-8-31**]

Date of Birth:  [**2109-5-26**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Iron

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
bacteremia

Major Surgical or Invasive Procedure:
[**2156-8-6**] - Aortic valve replacement with #23mm ST.[**Male First Name (un) 923**]
mechanical valve/Mitral valve replacement with #29mm St.[**Male First Name (un) 923**]
mechanical valve and  pericardial patch closure of aortic valve
annular abscess.

[**2156-8-29**] - peritoneal dialysis catheter - any questions call Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 3618**]


History of Present Illness:
Mr. [**Known lastname **] is a 47 year old male with End Stage Renal Disease
secondary to  hypertension, who was admitted to [**Hospital1 498**] [**Hospital1 1559**]
with an infected right groin hemodialysis line on [**2156-7-31**].  He
has had multiple access procedures, and the most recent
hemodialysis line was placed approximately two months ago by
[**Hospital1 18**] AV care. Due to his known central stenosis, a groin site
was chosen. For approximately one week, he has been having
yellow discharge around the catheter. He had HD on Friday, at
which time he had a temperature of 101 and yellow discharge.
Upon admission to [**Hospital1 498**], blood and wound cultures were obtained,
which grew Staph Aureus.  He was started on vancomycin, and the
catheter was removed.  He was transferred to [**Hospital1 18**] with
bacteremia from infected hemodialysis line for continued
management.

Past Medical History:
Endocarditis, Mitral Regurgitation, Hypertension, asthma,
anemia, restless leg syndrome, ESRD/HD, Gastric Esophageal
Reflux Disease, multiple AV grafts bilateral upper extremities,
bilateral nephrectomies for renal carcinoma, s/p bilateral
parathyroidectomy


Social History:
Currently incarcerated.
History of cocaine use.
No alcohol or tobacco


Family History:
Non-contributory.


Physical Exam:
Vitals: T 98.1, HR 81 a-fib, BP 100/62, RR 20, O2 94RA
Gen: awake/alert/oriented, no acute distress
CV: iregular rate and rhythm, no murmur
Resp: cta bilaterally, decreased in bases
Abd: soft, NT, ND, +BS
Extr:  AV grafts bilateral upper extremities, thrombosed;
palpable radial and pt/dp pulses; left groin catheter site
clean/dry/intact, no erythema/induration


Pertinent Results:
[**2156-8-30**] INR 2.5

130  90  26
 -----------<116
4.4  23  1.3 &#8710;

Mg: 2.2 P: 2.7


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  40% to 50%  >= 55%
Findings
LEFT ATRIUM: Mild LA enlargement. No spontaneous echo contrast
is seen in the LAA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. A catheter or
pacing wire is seen in the RA and extending into the RV. PFO is
present.
LEFT VENTRICLE: Normal LV [**Known lastname **] thickness and cavity size.
RIGHT VENTRICLE: Normal RV free [**Known lastname **] thickness. Mildly dilated
RV cavity. Mild global RV free [**Known lastname **] hypokinesis.
AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter. Normal aortic arch diameter. Normal
descending aorta diameter.
AORTIC VALVE: Three aortic valve leaflets. Aortic root abscess.
No AS. Trace AR.
MITRAL VALVE: Severely thickened/deformed mitral valve leaflets.
Large vegetation on mitral valve. Abscess cavity adjacent to
mitral valve. No MS. Moderate to severe (3+) MR.
TRICUSPID VALVE: Mild to moderate [[**2-1**]+] TR.
PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen.
PERICARDIUM: Very small pericardial effusion.
GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. The patient received antibiotic prophylaxis. The
TEE probe was passed with assistance from the anesthesioology
staff using a laryngoscope. No TEE related complications.
patient.
REGIONAL LEFT VENTRICULAR [**Known lastname **] MOTION:
     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PRE-CPB:1. The left atrium is mildly dilated. No spontaneous
echo contrast is seen in the left atrial appendage.
2. A patent foramen ovale is present.
3. Left ventricular [**Known lastname **] thicknesses and cavity size are normal.
4. The right ventricular free [**Known lastname **] thickness is normal. The
right ventricular cavity is mildly dilated with mild global free
[**Known lastname **] hypokinesis.
5. There are three aortic valve leaflets. An aortic annular
abscess is seen. There is no aortic valve stenosis. Trace aortic
regurgitation is seen.
6. The mitral valve leaflets are severely thickened/deformed.
There is a large vegetation on the mitral valve. There is an
abscess cavity seen adjacent to the mitral valve. Moderate to
severe (3+) mitral regurgitation is seen. There is a perforation
seen of the anterior leaflet.
7. There is a very small pericardial effusion.
Dr. [**Last Name (STitle) **] was notified in person of the results.
POST-CPB: On infusion of epi, levo, vasopressin. AV pacing, then
sinus rhythm. Well-seated mechanical valve in the mitral
position with normal washing jets seen. Aortic valve is poorly
seen in the deep transgastric view. There is a small
transvalvular gradien of 15 mmHG. There is an eccentric
paravalvuklar leak that originates near the anterior mitral
leaflet side of the aortic annulus. The jet is mild to moderate.
The LVEF is now 40% with inferior hypokinesis. The RV is
severely hypokinetic and dilated. There is 2+ TR. The aortic
contour is normal post decannulation.
  I certify that I was present for this procedure in compliance
with HCFA regulations.
Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD, on [**2156-8-6**] 13:17

Chest CT scan [**2156-8-30**]
A right lower lobe, air-fluid level containing, abscess is
unchanged, again 22
x 22mm. Note is also made of bilateral pleural effusions with
overlying
atelectasis/consolidation. Ground-glass opacities, such as that
in the right
upper [**Last Name (un) **] (4:56) are new, likely areas of developing
infection/inflammation.
Note is made of pericardial fluid, similar to [**0-0-0**].
Mediastinal gas has
resolved. A substernal hematoma is unchanged from [**0-0-0**].
Appearance of a
splenic infarct is unchanged. Patient is status post bilateral
nephrectomies,
aortic and mitral valve replacements. A right PICC traverses a
right
brachiocephalic vein stent. Extensive osseous sclerosis is
unchanged,
consistent with renal osteodystrophy.

DR. [**First Name (STitle) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
Wet read entered: MON [**2156-8-30**] 10:04 PM


Brief Hospital Course:
Mr. [**Known lastname **] was transferred from [**Hospital6 15083**] to the
transplant surgery service at [**Hospital1 18**] on [**2156-8-1**]. He is a 47 year
old male with End Stage Renal Disease secondary to hypertension,
who was admitted to [**Hospital1 498**] [**Hospital1 1559**] with an infected right groin
hemodialysis line on [**2156-7-31**].  He has had multiple access
procedures, and the most recent hemodialysis line was placed
approximately 2 months ago by [**Hospital1 18**] AV care. Due to his known
central stenosis, a groin site was chosen. For approximately 1
week prior to admission to [**Hospital1 498**] he had been having yellow
discharge around the catheter. He had hemodialysis on Friday, at
which time he had a temperature of 101 and yellow discharge.
Upon admission to [**Hospital1 498**], blood and wound cultures were obtained,
which grew Staph Aureus.  He was started on vancomycin, and the
catheter was removed.
He was transferred to [**Hospital1 18**] with bacteremia from an infected
hemodialysis line for continued management. He was on the
surgical floors for several days when he became septic and
hypotensive requiring pressors and a transfer to the surgical
intensive care unit. An echo revealed severe mitral
regurgitation with large vegetations. A transesophageal
echocardiogram also revealed an aortic annular abscess.
Infectious disease was consulted.  Cardiac surgery was consulted
and the usual pre-operative evaluation was initiated. On [**8-6**] he
became hypoxic and was intubated. Later that day he was brought
emergently to the operating room for aortic and mitral valve
replacements with Dr [**Last Name (STitle) **], please see operative report for
details. In  summary he had:
1. Emergent mitral valve replacement with a 29-mm St. [**Male First Name (un) 923**]
mechanical valve, reference number [**Serial Number 90136**].
2. Aortic valve replacement with a St. [**Male First Name (un) 923**] mechanical valve,
reference number [**Serial Number 90137**]. pericardial patch closure of aortic valve annular abscess.
His cardiopulmonary bypass time was 159 minutes with a
crossclamp time of 134 minutes. He tolerated the operation and
post-operatively was transferred to the cardiac surgery ICU on
Vasopressin, Epinephrine, Levophed, and Propofol infusions.
CVVHD was initiated on the day of surgery. He was labile and
hypoxic in the immediate post-op period and was kept sedated.
Additionally with any weaning of sedation he would become
profoundly agitated and vacillated between hypotension and
hypertension requiring resedation. He was also having episodes
of Atrial fibrillation which was initially treated with
Amiodarone that lead to bradycardia and discontinuation of the
Amiodarone. Electrophysiology was consulted and they advised the
avoidance of amiodarone. Patient returned to sinus rhythm for a
period and then went back into a-fib, he was eventually started
on Amiodarone without difficulty and his betablockers were
increaed for desired effect.  He presently is in rate controlled
a-fib with stable hemodynamics on amiodarone taper. His valve
cultures grew MRSA and he was given Gentamicin and Vancomycin.
He was placed on cefepime for ventilator associated  pneumonia.
He developed VRE bacteremia and enterocus pneumonia in the
postop period and required several mores days of pressor
therapy.  . He was initially extubated a few days after his
initial surgery but was reintubated for respiratory distress. He
was hemodynamically unstable with rising LFTs and Lactic acid,
work-up revealed, percardial hematoma causing tampanade and was
brought back to the OR on POD#6 for evacutaion.  He returned
with improved hemodynamics.  He remained intubated for several
more days afterwards, due to hypoxia due to fluid overload and
agitation.  He was again extubated on [**8-19**] and has continued to
do well. He required CVVH therapy and was transitioned to HD.
He contined to have access issues post-op, left AVF remained
clotted, and on POD#18 he had a left groin tunnelled HD cath
placed as well as a right PICC.  His amylase and lipase spiked
in the post-op period which was felt to be chemicially induced,
his diet was advanced and they have been trending down slowly.
His antibiotics were adjusted per ID, he was switched to
cefepime and daptomycin,  he was positive for c-diff and started
on PO vanco ([**8-18**])  A chest CT done o [**8-22**] as part of his
work-up for line placement revealed RLL abscess.A repeat Chest
CT was obtain prior to discharge and it showed an unchnaged
abcess (see reports.  His longterm dialysis plan is to do
peritoneal dialysis, therefore a PD cath was placed [**2156-8-28**]
(catheter can be used after 3 weeks). The plan is to continue
with HD until all antibiotics are dc'd (on [**2156-9-17**] ID will
determine this), afterwhich his PD can be initiated. ID has
requested that his lines be minimized prior to discharge,
therefore his antibiotics were chanaged to accomadate this plan.
 He was swithced to IV vanco three times a week after dialysis
to be infused through his HD line and cefepime was changed to
Cipro on day of discharge and he continues on oral vanco for
c-diff. All antibiotics are to be discontinued on [**9-17**] after his
ID appointment on that day.  He will need his peritoneal
dialysis cath flushed and dressing changed per policy. Heparin
was started for his double mechanical valve and his INR is
currently (2.5) therapeutic off heparin his INR goal is 2.5-3.5
.
Mr [**Known lastname **] remains in custody but has continued to progress and has
been deemed safe to be discharged [**Hospital6 90138**] in
[**Doctor First Name 3094**], MA on Rt 57 for further strengthening, conditioning and
medical management

PO amiodarone started on [**8-25**] for post-op A-fib

***He has an Anti-C antibody which could lead to a delayed
transfusion reaction in the future.***


Medications on Admission:
Meds on [**Hospital1 498**] transfer: ventolin 60mg daily, asa 81mg daily,
sinemet 25/250 2
tabs qhs, benadryl 25mg TID, colace 100mg [**Hospital1 **], labetalol 300mg
[**Hospital1 **],
sevelamer 4000mg TID, Vancomycin 1g daily, verapamil 480mg daily


Discharge Medications:
1. metoprolol tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
5. clonidine 0.3 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly
Transdermal QFRI (every Friday).
6. carbidopa-levodopa 25-250 mg Tablet Sig: One (1) Tablet PO HS
(at bedtime).
7. heparin (porcine) 1,000 unit/mL Solution Sig: 3000-10,000
unit dwell Injection DAILY (Daily).
8. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
9. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO Q8H
(every 8 hours) as needed for constipation.
10. sevelamer carbonate 800 mg Tablet Sig: One (1) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
11. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
12. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
HS (at bedtime) as needed for constipation.
13. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): decrease to 400mg daily on [**2156-9-6**] then decrease to 200mg
daily ongoing on [**2156-9-13**].
14. ipratropium-albuterol 18-103 mcg/Actuation Aerosol Sig: [**2-1**]
Puffs Inhalation Q6H (every 6 hours).
15. guaifenesin 600 mg Tablet Extended Release Sig: Two (2)
Tablet Extended Release PO BID (2 times a day).
16. vancomycin 250 mg Capsule Sig: Two (2) Capsule PO Q6H (every
6 hours) for 1 days: last dose mid night [**2156-9-1**].
17. ipratropium bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for dyspnea.
18. warfarin 7.5 mg Tablet Sig: One (1) Tablet PO once a day:
Goal INR 2.5-3.5 for mechcanical MVR/AVR
IF INR falls below 2.5- needs IV heparin until INR >2.5.
19. Outpatient Lab Work
Check INR daily for one week then 3 times weekly then
mon/wed/fri for 2 weeks until on stable coumadin dose with
stable INR then at least monthly maintenance.
20. vancomycin in D5W 1 gram/200 mL Piggyback Sig: One (1) gm
Intravenous HD PROTOCOL (HD Protochol):  dose through [**2156-9-17**]-
and duration will be determined at ID follow up .
21. line flushes

Tunneled Access Line (e.g. Hickman), heparin dependent: Flush
with 10 mL Normal saline followed by Heparin as above daily and
PRN per lumen.

22. Cipro 500 mg Tablet Sig: One (1) Tablet PO once a day:
duration will be determined at follow up appointment with
infectious disease.
23. oxycodone 5 mg Capsule Sig: One (1) Capsule PO q4hrs as
needed for pain.
Disp:*65 Capsule(s)* Refills:*0*
24. Ativan 0.5 mg Tablet Sig: One (1) Tablet PO q6hrs as needed
for anxiety.
Disp:*60 Tablet(s)* Refills:*0*
25. peritoneal dialysis catheter
Flushes per protocol
[**2156-8-29**] peritoneal dialysis catheter placed- any questions call
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 3618**]


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 32674**] - [**Location (un) **]

Discharge Diagnosis:
s/p Aortic valve replacement with #23mm ST. [**Male First Name (un) 923**] mechanical
valve/Mitral valve replacement with #29mm St.[**Male First Name (un) 923**] mechanical
valve and  pericardial patch closure of aortic valve annular
abscess.

Reoperation for evacuation of mediastinal hematoma

PMH: Endocarditis, Mitral Regurgitation, Hypertension, End Stage
Renal Disease/Hemodialysis x16 years secondary to hypertensive
nephropathy- Asthma, Anemia, Restless leg syndrome, Gastric
Esophageal Reflux Disease, s/p bilateral nephrectomies for renal
carcinoma, s/p bilateral parathyroidectomy, s/p multiple
AortoVenous graft placements- bilateral Upper Extremities



Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with assist
Incisional pain managed with tylenol sensitive to narcotics
Incisions:
Sternal - healing well, no erythema or drainage  healing well,
no erythema or drainage.
Stage 3 decubitus wound
Extremities: Lower extremities: 1+ Edema;  +[**3-4**] left upper
extremity


Discharge Instructions:
1) AFTER YOUR dialysis catheter in your groin is REMOVED: Please
shower daily including washing incisions gently with mild soap,
no baths or swimming until cleared by surgeon. Look at your
incisions daily for redness or drainage
2) Please NO lotions, cream, powder, or ointments to incisions
3) Each morning you should weigh yourself and then in the
evening take your temperature, these should be written down on
the chart
4) No lifting more than 10 pounds for 10 weeks
5) Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr. [**Last Name (STitle) **]  Date/Time:[**2156-9-8**] 1:00 [**Telephone/Fax (1) 170**] [**Hospital **]
Medical Building [**Hospital Unit Name **]
Cardiologist: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2156-9-20**] 1:20

Infectious Disease Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]  [**Telephone/Fax (1) 457**] [**9-14**] at
10:30am in [**Hospital **] medical office building basement [**Doctor First Name **]
Bsoton Ma

[**2156-8-29**] - peritoneal dialysis catheter - any questions call Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 3618**]



Completed by:[**2156-9-1**]
{'Other and unspecified infection due to central venous catheter,Acute and subacute bacterial endocarditis,Methicillin resistant Staphylococcus aureus septicemia,End stage renal disease,Abscess of lung,Severe sepsis,Acute respiratory failure,Pneumonia due to other Streptococcus,Cardiogenic shock,Cardiac tamponade,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Intestinal infection due to Clostridium difficile,Acute pericarditis, unspecified,Cardiac complications, not elsewhere classified,Atrioventricular block, complete,Hemorrhage complicating a procedure,Pressure ulcer, stage III,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Acquired absence of kidney,Other iatrogenic hypotension,Personal history of malignant neoplasm of kidney,Atrial fibrillation'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: bacteremia

PRESENT ILLNESS: Mr. [**Known lastname **] is a 47 year old male with End Stage Renal Disease
secondary to  hypertension, who was admitted to [**Hospital1 498**] [**Hospital1 1559**]
with an infected right groin hemodialysis line on [**2156-7-31**].  He
has had multiple access procedures, and the most recent
hemodialysis line was placed approximately two months ago by
[**Hospital1 18**] AV care. Due to his known central stenosis, a groin site
was chosen. For approximately one week, he has been having
yellow discharge around the catheter. He had HD on Friday, at
which time he had a temperature of 101 and yellow discharge.
Upon admission to [**Hospital1 498**], blood and wound cultures were obtained,
which grew Staph Aureus.  He was started on vancomycin, and the
catheter was removed.  He was transferred to [**Hospital1 18**] with
bacteremia from infected hemodialysis line for continued
management.

MEDICAL HISTORY: Endocarditis, Mitral Regurgitation, Hypertension, asthma,
anemia, restless leg syndrome, ESRD/HD, Gastric Esophageal
Reflux Disease, multiple AV grafts bilateral upper extremities,
bilateral nephrectomies for renal carcinoma, s/p bilateral
parathyroidectomy

MEDICATION ON ADMISSION: Meds on [**Hospital1 498**] transfer: ventolin 60mg daily, asa 81mg daily,
sinemet 25/250 2
tabs qhs, benadryl 25mg TID, colace 100mg [**Hospital1 **], labetalol 300mg
[**Hospital1 **],
sevelamer 4000mg TID, Vancomycin 1g daily, verapamil 480mg daily

ALLERGIES: Iron

PHYSICAL EXAM: Vitals: T 98.1, HR 81 a-fib, BP 100/62, RR 20, O2 94RA
Gen: awake/alert/oriented, no acute distress
CV: iregular rate and rhythm, no murmur
Resp: cta bilaterally, decreased in bases
Abd: soft, NT, ND, +BS
Extr:  AV grafts bilateral upper extremities, thrombosed;
palpable radial and pt/dp pulses; left groin catheter site
clean/dry/intact, no erythema/induration

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Currently incarcerated.
History of cocaine use.
No alcohol or tobacco 

### Response:
{'Other and unspecified infection due to central venous catheter,Acute and subacute bacterial endocarditis,Methicillin resistant Staphylococcus aureus septicemia,End stage renal disease,Abscess of lung,Severe sepsis,Acute respiratory failure,Pneumonia due to other Streptococcus,Cardiogenic shock,Cardiac tamponade,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Intestinal infection due to Clostridium difficile,Acute pericarditis, unspecified,Cardiac complications, not elsewhere classified,Atrioventricular block, complete,Hemorrhage complicating a procedure,Pressure ulcer, stage III,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Acquired absence of kidney,Other iatrogenic hypotension,Personal history of malignant neoplasm of kidney,Atrial fibrillation'}
