Central line-associated bloodstream infection Quiz: Ace Your Exams

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A 62-year-old man is admitted to the intensive care unit for acute decompensated heart failure. Past medical history is significant for coronary artery disease and end-stage renal disease on hemodialysis via an internal jugular venous catheter. The patient has challenging venous anatomy and has had significant difficulty with obtaining venous access in the past. On day 4 of the hospitalization, the patient develops chills and a fever of 38.5°C (101.3°F). Pulse is 90/min, blood pressure is 113/74mmHg, respiratory rate is 14/min, and oxygen saturation is 97% on room air. Physical examination is significant for tenderness and erythema at the catheter site. Laboratory evaluation is significant for leukocytosis and elevated C-reactive protein. Blood cultures from two peripheral sites grow Gram-positive cocci in clusters. Which of the following is the best next step in the management of this patient?

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Attempt central line lock therapy with IV vancomycin

Remove the central line and start IV caspofungin

Attempt central line lock therapy with IV gentamicin

Await blood culture sensitivities before starting antibiotics

Remove the central line and start IV vancomycin