A 60-year-old man on ICU develops fever on day 12. He has a tunnelled CVC, urinary catheter, and ETT. Blood cultures from the CVC grow coagulase-negat...

Question

A 60-year-old man on ICU develops fever on day 12. He has a tunnelled CVC, urinary catheter, and ETT. Blood cultures from the CVC grow coagulase-negative staphylococci (CoNS) in BOTH bottles at 16 hours, and peripheral blood cultures grow the same CoNS at 22 hours. This time the growth pattern appears genuine. What is the significance and management?

Accepted Answer

CoNS growing in multiple bottles (both CVC and peripheral) with consistent identification and DTP >= 2 hours (CVC positive 6 hours before peripheral) is consistent with true CRBSI - remove the CVC, start IV vancomycin, and treat for 7-14 days depending on the clinical response

Answer

This is always contamination - ignore

Answer

Only treat if the patient is in septic shock

Answer

Switch to oral antibiotics immediately

Answer

CoNS can never cause true bloodstream infection

uk-fficm MCQ (SBA): CoNS CRBSI