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CRBSI — RACP Adult Medicine MCQ

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HardInfectious DiseasesCRBSIRACP Adult Medicine

A 55-year-old woman undergoing treatment for breast cancer with docetaxel develops sudden onset fever (39.5°C) and breathlessness on day 8 of cycle 3. Her ANC is 0.1 × 10⁹/L. She has a tunnelled central venous catheter (Hickman line). Blood cultures from both the line and peripheral site grow coagulase-negative staphylococci. In addition to broad-spectrum antibiotics, what line management is needed?

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Correct answer: B — Antibiotic lock therapy and attempt line salvage

For uncomplicated catheter-related bloodstream infection (CRBSI) with coagulase-negative staphylococci (a low-virulence organism) in a patient who needs ongoing venous access, antibiotic lock therapy with systemic antibiotics and attempted line salvage is appropriate. Immediate catheter removal is indicated for: S. aureus, Candida species, Pseudomonas, tunnel infection, septic thrombophlebitis, endocarditis, or haemodynamic instability. Line salvage success rate for CoNS is ~75–80%.

Reference: eTG – 2025 – Antibiotic Guidelines; IDSA – 2009 – Intravascular Catheter Infection Guidelines