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Internal Medicine

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A 55-year-old man who recently underwent coronary artery bypass graft surgery, developed fever and chills on postoperative day 3. Blood cultures grew coagulase-negative Staphylococcus, identified as Staphylococcus lugdunensis, which is sensitive to oxacillin and vancomycin. He also has a new systolic murmur and a newly prolonged PR interval on ECG. Repeated blood culture is negative.



Which of the following you should recommend now?

  • No further work up is needed

  • Treat with oxacillin for one week

  • Treat with vancomycin for one week

  • Order an echocardiogram




  • Staphylococcus lugdunensis: Though a coagulase-negative staphylococcus (CoNS), it behaves more like Staphylococcus aureus in terms of virulence and can cause endocarditis.

  • Staphylococcus epidermidis and Staphylococcus saprophyticus: Typically less virulent and more commonly associated with indwelling catheter infections rather than causing significant systemic illness like endocarditis.

  • Staphylococcus pseudintermedius: Primarily an animal pathogen.

  • Staphylococcus argenteus: Rare and less commonly associated with such presentations.


The clinical scenario of a new heart murmur, systemic symptoms, and positive blood cultures for a virulent coagulase-negative staphylococcus strongly points towards Staphylococcus lugdunensis as the most likely cause.

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