Critical Care Medicine-Infections and Immunologic Disease>>>>>Cardiovascular Infections
Question 1#

A 19-year-old male with no past medical history presented to the emergency room with pelvic fracture after being hit by a car. A central line was placed for administering vasopressors and volume resuscitation. Three days later, the patient became febrile, and blood cultures were obtained revealing Staphylococcus aureus. Vancomycin was started, and repeat blood cultures 2 days later are negative. Transthoracic echocardiogram is unremarkable.

Which of the following is the next best step?

A. Transesophageal echocardiogram
B. Antibiotic lock therapy
C. Central line removal
D. Antibiotics for 7 days

Correct Answer is C


Correct Answer: C

This patient with likely Staphylococcus aureus catheter-related blood stream infection (CRBSI) without evidence of endocarditis should have catheters removed and receive antibiotic therapy for 14 days. Salvage therapy using catheter exchange over a guidewire or antibiotic lock therapy should generally be avoided, given increased morbidity, mortality, treatment failure, and recurrence in patients with Staphylococcus aureus CRBSI. In spite of a negative transthoracic echocardiogram, a transesophageal echocardiogram is necessary in patients with signs or symptoms of endocarditis, prior history of endocarditis, positive blood cultures after 72 hours despite appropriate antibiotic treatment, a previously placed port or other indwelling vascular device, hemodialysis, a prosthetic valve, cardiac structural and valvular abnormalities, an implantable pacemaker, an intravenous drug abuse, and absence of a reasonable reason for infection.


  1. Mirrakhimov AE, Jesinger ME, Ayach T, Gray A. When does S aureus bacteremia require transesophageal echocardiography? Cleve Clin J Med. 2018;85(7):517-520.
  2. Chaves F, Garnacho-montero J, Del pozo JL, et al. Diagnosis and treatment of catheter-related bloodstream infection: clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva. 2018;42(1):5-36.