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CoNS CRBSI Management — SCE Infectious Diseases MCQ

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EasyHealthcare-Associated InfectionsCoNS CRBSI ManagementSCE Infectious Diseases

A 55-year-old man develops a catheter-related bloodstream infection with Staphylococcus capitis. The central line has been in situ for 3 weeks. Blood cultures from the line and peripheral site are both positive with a DTP (differential time to positivity) of 4 hours (line culture positive first). The patient is haemodynamically stable. He has no prosthetic material other than the central line. What is the management?

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Correct answer: E — Remove the central venous catheter and treat with IV Vancomycin (or Flucloxacillin if methicillin-sensitive) for 5–7 days for uncomplicated CoNS CRBSI

Coagulase-negative staphylococcal CRBSI (confirmed by DTP ≥2 hours and two positive cultures) is managed with catheter removal plus short-course antibiotics (5–7 days for uncomplicated CoNS CRBSI without endovascular complications). This is shorter than S. aureus CRBSI (minimum 14 days). Uncomplicated CoNS CRBSI is defined as: prompt blood culture clearance, no prosthetic material (other than the removed line), no endocarditis, and no metastatic infection. TOE is not routinely required for CoNS CRBSI (unlike S. aureus).

Reference: IDSA 2009 – CRBSI; NICE NG139 2019 – HAI