A male newborn, born at 41 weeks' gestation and weighing 3230 g, presented on the first day of life with complex cyanotic heart disease, including the following signs: double-outlet right ventricle, mitral atresia with hypoplastic left ventricle, and hypoplastic aortic arch with coarctation. He was transferred to a level-3 nursery at age 12 days. He underwent pulmonary artery banding, repair of the coarctation of the aorta, and ligation of a patent ductus arteriosus. Congestive heart failure continued after surgery, and the patient was maintained on total parenteral nutrition administered through a double-lumen femoral venous catheter that had been placed during surgery. Eleven days after surgery, he was pale, poorly perfused, and tachypneic.
A septic workup was performed and cultures of blood, urine, and cerebrospinal fluid were obtained.