Peadiatric case

Patient of 14 year old came with fever, vomitings and SOB since 3 days and patient has history of TOF and underwent surgery,Patient is having TF and right ventricular dysfunction in 2d echo . In the USG reports he has cholelithiasis and there is continuous fever spikes from past three days and he is on the medication but there is no relief from fever can anyone help in diagnosing the case. Vitals are PR-130bpm Bp-90/50 Saturation is maintaining at 85-90

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I think the clinical features are suggestive of a case of INFECTIVE ENDOCARDITIS Undergone heart surgery is a risk factor Presence of fever not responding to conventional treatment Patient should be started on Ceftriaxone plus Gentamicin empirically Blood culture (at least 2,taken 24 hrs apart) should be sent Chest X ray should be done and any other focus of infection should be looked for Vancomycin should be omitted I think (poor choice as a 1st line if there is nothing pointing towards MRSA) Clinical examination findings should be mentioned
Thank you doctor
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? Infective endocarditis ? DCM. Adv CPK-MB, BLD culture. I think vancomycin should be given with renal adjustment doses bcz creat is increased in this case. Or start linazolid with pipercillin and genta.
Thank you doctor
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