clindamycin administration . The patient was transferred from the emergency department to the ICU in stable condition . Here , he was noted to have done well without any respiratory complications overnight , maintaining an oxygen saturation range of 91-94 % on room air . He was placed on a schedule of IVPB clindamycin , 900 mg / 50 mL every eight hours , and IV dexamethasone , 4 mg every six hours . He also had scheduled ipratropium-albuterol ( DuoNeb ), 3 mL every six hours PRN , as well as routine aerosol treatments every four hours . He was placed on NPO diet .
On hospital day two , ENT evaluated the patient and found him to report significant improvement overnight in his sore throat , dysphagia , and hoarseness . He was noted to be handling his own secretions and denied any dyspnea , otalgia , hemoptysis , or continued odynophagia . From an ENT standpoint , he was deemed stable for transfer from the ICU to a medical-surgical floor , with anticipated discharge home the following day . He was also deemed appropriate to start a full liquid diet and advance to regular diet as tolerated . He continued to receive medications as originally scheduled .
By hospital day three , one of three blood culture bottles collected from his stay in the emergency department showed presence of aerobic gram-positive cocci in clusters . A MRSA / SA Blood Culture Assay did not detect Staphylococcus aureus . He was re-evaluated by ENT and noted to have significant improvement in quality of voice and resolution of dysphagia and odynophagia . His physical exam was unremarkable , and he was cleared for hospital discharge from ENT standpoint .
Discussion
Acute epiglottitis is a potentially life-threatening illness characterized by inflammation of the epiglottis as well as the nearby supraglottic structures . It is known to affect both children and adults , though their etiologies may differ . In adults , epiglottitis is commonly bacterial in origin , though viral origin may be suspected if no pathogen can be isolated . 2 The most common bacterial cause of epiglottitis in adults is known to be Group A beta-hemolytic Streptococci . 3 Other bacterial causes include Haemophilus influenzae type B ( Hib ), Streptococcus pneumoniae , and Staphylococcus aureus , among others . Known viral causes include herpes simplex , varicella , and parainfluenza . 4
Prior to further workup in the emergency department , our patient was noted in urgent care to have a negative rapid Strep A screening test and a negative Mononucleosis test . Blood cultures collected during his stay in the emergency department eventually showed growth of gram-positive cocci in clusters in one of the bottles interpreted . Gram-positive cocci that specifically grow in clusters are known to be Staphylococcus , as opposed to Streptococcus , being gram-positive cocci that grow in chains . Additionally for our patient , Staphylococcus aureus was not detected on MRSA / SA Blood Culture Assay . S . aureus is differentiated from the other subdivisions of staphylococci in that it is classified as coagulase-positive , whereas S . epidermidis and S . saprophyticus are classified as coagulase-negative . As S . aureus was not detected in our patient , the bacteria present could be construed as coagulase-negative . The clinical significance of positive cultures can vary depending on the circumstances – it is known that if a coagulase-negative Staphylococcus is found in only one bottle from a set of blood cultures , the isolate is likely a contaminant . 5 As this was the case for our patient , the positive culture finding is most likely clinically insignificant .
( Continued on page 118 )
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Volume 118 • Number 5 nOVEMBER 2021 • 117