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Neonatal Hyperbilirubinemia — USMLE Step 2 CK MCQ

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HardPediatricsNeonatal HyperbilirubinemiaUSMLE Step 2 CK

A 58-year-old ICU patient with a central venous catheter has candidemia. An echinocandin was started yesterday. The catheter is no longer essential, ophthalmic symptoms are absent and repeat cultures are planned. Which additional step is most appropriate?

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Correct answer: A — Remove the central venous catheter as early as feasible

An unnecessary central venous catheter that is the presumed candidemia source should be removed as early as feasible. Waiting for the first negative culture or completion of echinocandin therapy prolongs exposure to an infected device, and guidewire exchange does not provide adequate source control. Fluconazole step-down requires clinical stability, a susceptible isolate and negative follow-up cultures; it should not delay line removal. IDSA also recommends a dilated ophthalmologic examination within the first week for nonneutropenic candidemia, but that separate evaluation does not delay catheter source control.

Reference: IDSA clinical practice guideline for candidiasis: https://www.idsociety.org/practice-guideline/candidiasis/