<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 27-year-old man presents to the emergency department for altered mental status. The patient was found napping in a local market and brought to the hospital. The patient has a past medical history of polysubstance abuse and is homeless. His temperature is 104F 40.0C, blood pressure is 10052 mmHg, pulse is 133min, respirations are 25min, and oxygen saturation is 99 on room air. Physical exam is notable for an altered man. Cardiopulmonary exam reveals a murmur over the left lower sternal border. A bedside ultrasound reveals a vegetation on the tricuspid valve. The patient is ultimately started on IV fluids, norepinephrine, vasopressin, vancomycin, and piperacillin-tazobactam. A central line is immediately placed in the internal jugular vein and the femoral vein secondary to poor IV access. Cardiothoracic surgery subsequently intervenes to remove the vegetation. While recovering in the ICU, days 3-5 are notable for an improvement in the patients symptoms. Two additional peripheral IVs are placed while in the ICU on day 5, and the femoral line is removed. On day 6, the patients fever and hemodynamic status worsen. Though he is currently responding and not complaining of any symptoms including headache, photophobia, neck stiffness, or pain, he states he is feeling weak. Jolt accentuation of headache is negative and his abdominal exam is benign. A chest radiograph, urinalysis, and echocardiogram are unremarkable though the patients blood cultures are positive when drawn. Which of the following is the best next step in management?? A: Add cefepime to the patients antibiotics, B: Add micafungin to the patients antibiotics, C: Remove all peripheral IVs and send for cultures, D: Remove the central line and send for cultures, E: Perform a lumbar puncture,  <response>: This is a question about a 27-year-old man with altered mental status and a history of polysubstance abuse and homelessness. He is found to have endocarditis with a vegetation on his tricuspid valve. He undergoes surgery to remove the vegetation and is started on antibiotics. After initial improvement, his condition worsens again on day 6. His blood cultures are positive, suggesting ongoing infection, but other tests are unremarkable. The key here is that he has a central line in place, which is a potential source of bloodstream infection. Even though he is not showing clear signs of meningitis, the positive blood cultures in the setting of worsening fever and hemodynamics raises concern for seeding of infection to the central nervous system. Therefore, the best next step is to remove the central line and send it for cultures to identify if it is the source of ongoing infection.Choices A and B are less optimal because they add new antibiotics without addressing the potential source of infection. Choice C removes peripheral IVs which are less likely to be the cause. Choice E is premature without clearer neurological signs concerning for meningitis.D: Remove the central line and send for cultures 