2.  Gram-negative bacteremia.  On the morning of June 27, 2008, Ms. ABC did spike a fever.  She was started on empiric antibiotics with cefepime and vancomycin.  Cultures were drawn peripherally and from the Port-A-Cath which both grew out Gram-negative rods within 12 hours.  After being initiated on IV antibiotics, she remained afebrile for the remainder of the hospitalization.  Both cultures eventually grew out Proteus mirabilis, which was pansensitive.  She had three additional blood cultures, which were all negative.  On the day prior to discharge, she was transitioned to oral Cipro and remained afebrile.  We had intended to send her home with oral antibiotics; however, by day of discharge, she was pancytopenic and it was decided that she should be discharged to complete a 14-day course of IV antibiotics with cefepime.  She will continue this with the assistance of home health services.  She was advised to follow neutropenic precautions and labs will be followed closely as an outpatient.  She understands if she develops a fever greater than 100.5, she should call to return immediately for admission.