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CoNS Catheter BSI Salvage vs Removal — ESENeph MCQ

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ModerateHaemodialysisCoNS Catheter BSI Salvage vs RemovalESENeph

A 60-year-old man with CKD G5D on HD has a catheter tip culture growing coagulase-negative Staphylococcus after catheter removal for persistent infection. Was catheter removal appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Catheter removal is appropriate for persistent CoNS bacteraemia (positive cultures >72 hours despite appropriate antibiotics) or complicated infection (metastatic infection, tunnel abscess); for uncomplicated CoNS with rapid culture clearance, antibiotic lock therapy may salvage the catheter

CoNS is the most common organism in catheter-related BSI in HD patients. Management depends on clinical response: (1) uncomplicated CoNS BSI (clinically well, cultures clearing within 48-72 hours of antibiotics): antibiotic lock therapy + systemic antibiotics for 2-3 weeks can salvage the catheter; (2) complicated CoNS BSI (persistent positive cultures >72 hours, metastatic infection, tunnel infection): catheter removal is indicated. UKKA and IDSA guidelines support catheter salvage for uncomplicated CoNS but removal for persistent or complicated infections. This organism, while often considered low-virulence, can cause significant morbidity in dialysis patients.

Reference: UKKA 2019 – VA; IDSA 2009 – Catheter Infection