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Tunnel Infection Line Removal — SCE Infectious Diseases MCQ

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EasyHealthcare-Associated InfectionsTunnel Infection Line RemovalSCE Infectious Diseases

A 60-year-old man with a tunnelled central line develops exit-site infection that progresses to tunnel infection (erythema and induration tracking along the subcutaneous tunnel from the exit site). Blood cultures are pending. What is the management?

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Correct answer: E — Remove the line — tunnel infection (unlike uncomplicated exit-site infection) mandates line removal plus systemic antibiotics

Tunnel infection (erythema/tenderness/induration tracking along the subcutaneous catheter tunnel) mandates line removal — unlike simple exit-site infection which may be managed with the line in situ. The rationale: the tunnel provides a biofilm-coated conduit that cannot be sterilised with antibiotics alone. After removal, systemic antibiotics are given for 10–14 days (guided by catheter tip and blood cultures). A new line should be inserted at a different site after a suitable interval (48–72 hours with documented blood culture clearance).

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