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CLABSI Management — FRCA Final MCQ

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ModerateIntensive Care MedicineCLABSI ManagementFRCA Final

A 60-year-old man in ICU following oesophagectomy has been receiving TPN via a central line. On day 10 he develops fever (38.8°C) with rigors. Blood cultures grow coagulase-negative staphylococci from the central line and peripherally. No other source of infection is identified. What is the management?

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Correct answer: C — Remove the central line and insert a new one at a different site

Confirmed central line-associated bloodstream infection (CLABSI) with coagulase-negative staphylococci requires line removal and insertion of a new line at a different site. The infected line is a persistent nidus of infection and will not clear with antibiotics alone in most cases. Blood cultures should be repeated 48-72 hours after line removal to confirm clearance. The duration of systemic antibiotics depends on the organism and clinical response – typically 5-7 days for uncomplicated coagulase-negative staph CLABSI. Guidewire exchange is NOT appropriate for infected lines.

Reference: NICE – 2017 – CG139 Healthcare-associated infections; ICS – 2023 – CLABSI prevention bundle