MRSA Catheter Bacteraemia — ESENeph MCQ

Correct answer: C — Remove the catheter and continue prolonged targeted antibiotics

The best answer is “Remove the catheter and continue prolonged targeted antibiotics”. Persistent MRSA bacteraemia despite active therapy requires catheter removal, repeat cultures and assessment for endocarditis or metastatic infection. Antibiotic duration is counted from clearance and tailored to complications. “Retain the catheter and stop antibiotics when fever resolves” is less appropriate because persistent S. aureus bacteraemia carries metastatic infection and relapse risk “Exchange the external catheter cap while retaining the tunnelled line” is less appropriate because the infected tunnel and intravascular segment remain in place “Use topical antibiotic at the exit site as definitive treatment” is less appropriate because topical therapy cannot treat persistent bloodstream infection “Insert the new catheter through the infected tunnel” is less appropriate because new access should avoid the infected site where feasible

Reference: UK Kidney Association vascular access guideline: https://www.ukkidney.org/health-professionals/guidelines/vascular-access-haemodialysis-0