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Catheter Exit Site Infection Penicillin Allergy — ESENeph MCQ

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EasyHaemodialysisCatheter Exit Site Infection Penicillin AllergyESENeph

A 50-year-old man on haemodialysis via a tunnelled catheter develops exit site redness and purulent discharge. Swab grows MSSA. There is no systemic infection and blood cultures are negative. He is allergic to Penicillin (anaphylaxis). What is the appropriate treatment?

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Correct answer: B — Oral Clindamycin or Doxycycline based on sensitivities (Penicillin-allergic); topical Mupirocin to exit site

For a tunnelled catheter exit site infection with MSSA in a Penicillin-allergic patient (anaphylaxis history), alternative oral antibiotics include Clindamycin, Doxycycline, or Co-trimoxazole, guided by sensitivities. Topical Mupirocin to the exit site is an adjunctive measure. Cephalosporins may be cautiously considered (cross-reactivity risk <2% with anaphylactic Penicillin allergy), but alternatives are preferred. IV Vancomycin is reserved for systemic infection (positive blood cultures, sepsis) or MRSA. Catheter removal is for refractory infections only.

Reference: UKKA 2019 – Vascular Access; IDSA 2009 – Catheter Infection