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Catheter-related bloodstream infection with sepsis — RCPSC EM MCQ

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HardInfectious disease emergenciesCatheter-related bloodstream infection with sepsisRCPSC EM

A patient with a chemotherapy port has fever, hypotension, lactate 4.6 mmol/L and erythema tracking along the catheter tunnel. Peripheral and line cultures have been obtained. What is the appropriate initial antimicrobial and source-control plan?

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Correct answer: E — Start vancomycin plus gram-negative coverage and assess source control

The best answer is “Start vancomycin plus gram-negative coverage and assess source control”. This is septic shock with suspected line-related bloodstream infection. In haemodynamic instability, empiric therapy includes gram-positive coverage such as vancomycin plus gram-negative coverage, while the line is assessed for removal or other source control. Culture results refine therapy but cannot precede resuscitation and antibiotics.

Reference: Emergency Care BC: Line-Related Infections: https://emergencycarebc.ca/clinical_resource/clinical-summary/line-related-infections/