What is the general approach to catheter-related bloodstream infection in a patient with a central venous catheter?

• A. Do nothing.
• B. Only antifungal therapy.
• C. Immediately remove catheter and stop antibiotics.
• D. Obtain blood cultures, remove or replace the catheter if appropriate, start empiric broad-spectrum antibiotics with Gram-positive and Gram-negative coverage, tailor therapy to culture results.

Answer: (D)

Prompt evaluation and source control are essential when a central venous catheter is implicated in bloodstream infection. Start by drawing blood cultures before antibiotics if possible, ideally from both the catheter and a peripheral vein to help confirm catheter-related bacteremia. Remove or replace the catheter if infection is suspected or proven, especially in cases of persistent bacteremia, fungemia, Staphylococcus aureus, Candida, or when the catheter is unlikely to be the source without removal. Begin empiric broad-spectrum antibiotics immediately to cover both Gram-positive and Gram-negative organisms, so you don’t wait for culture results. This typically includes coverage for MRSA and Gram-negative pathogens, with the specific regimen guided by local resistance patterns and patient risk factors. Once culture results return, tailor therapy to the identified organism and susceptibilities, narrowing the spectrum and adjusting duration as appropriate. The idea is to combine prompt diagnosis, source control, and timely, broad initial therapy with subsequent targeted treatment.