Ben is a 68-year old surgical patient. He initially presented to A&E with RIF pain and vomiting. A CT of his abdomen revealed a caecal tumour with perforation and peritonitis.
He underwent an emergency right hemicolectomy and a defunctioning loop ileostomy. Histology revealed a poorly differentiated adenocarcinoma.
Post-operatively he developed a fever and leucocytosis with a WCC of 24. Examination of the surgical site revealed a wound infection. Wound swabs grew Staphlocccus aureus and Bacteroides fragilis.
Desite a 10-day course of intravenous cefotaxime, flucloxacillin and metronidazole he remains pyrexial with a temperature of 39-40 C. At 2 weeks post-op he is unwell, unable to tolerate oral feeds, and is receiving parenteral nutrition via a central line. He also has a urinary catheter in-situ.
What are the possible causes of the persistant fever and leucocytosis?
What steps should be taken to identify the source and aetiology of the probable infection?
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