Central line-associated bloodstream infection Quiz: Ace Your Exams

A 53-year-old man is brought to the emergency department by his partner with a one-day history of altered mental status, fever, and chills. The patient was recently diagnosed with small-cell lung cancer and received the first cycle of chemotherapy last week. Past medical history is otherwise unremarkable. The patient has a 30 pack-year smoking history. Temperature is 39.4°C (102.9°F), pulse is 126/min, blood pressure is 89/64 mmHg, and respiratory rate is 18/min. On physical examination, the patient appears ill and is oriented to place but not to person or time. The patient moves all limbs and has normal reflexes bilaterally. There is no neck stiffness. There is a right chest wall central line in place with marked erythema, tenderness, and purulence at the insertion site. Laboratory evaluation is significant for leukocytosis with left shift and an elevated lactate. Peripheral IV access is established; IV fluids are administered and two sets of blood cultures are obtained from different sites. Which of the following is the best next step in management?