A 26-Year-Old Man with Testicular Cancer Who Is Receiving Chemotherapy

A 26-year-old man with testicular cancer who is receiving chemotherapy is evaluated in the emergency department. His temperature is 38.9 °C (102 °F) , and he complains of feeling flushed and tired. He has an indwelling central venous port, but there are no localizing symptoms to suggest a source of infection. Chest radiograph shows no abnormalities. The patients hemoglobin is 8.9 gIdL; the absolute neutrophil count is 165/?L and the platelet count is 56,000/?L. Results of other laboratory studies and urinalysis are within normal limits. Blood samples are obtained from a peripheral vein and through the port and sent for culture; a urine culture is also ordered. The patient is hospitalized and intravenous ceftazidime is initiated. Three days later, the patient"s temperature is 37.8 °C (100 °F) and absolute neutrophil count is 4504/?L; his clinical condition is otherwise stable. Results of blood and urine cultures are negative. A repeat chest radiograph is normal, and blood and urine speci

A) Continue the current antibiotic regimen
B) Add vancomycin
C) Switch to oral ciprofloxacin and amoxicillin-clavulanic acid
D) Add granulocyte colony-stimulating factor
E) Remove the central venous port