1. What is the most likely diagnosis?
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The most likely diagnosis, in this case, is line sepsis.
Central venous catheters are a common source of infection and should be suspected as a source of sepsis in any patient that has had a line in situ for a prolonged period (usually longer than a week).
Diagnosis can be difficult, and it is important to note that only 50% of patients with line sepsis have evidence of infection at the insertion site.
The following features are indicative of the vascular catheter as the source of infection:
- Bacteraemia (or fungaemia) in an immunocompetent patient without any underlying disease
- Absence of another identifiable source of infection
- Presence of a vascular catheter (or alternative intravascular device) at the onset of fever
- Inflammation or purulence at the catheter insertion site or along the tunnel
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The current recommendation by NICE and the BNF on the treatment of septicaemia related to vascular catheters is to use vancomycin first-line.
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If Gram-negative sepsis is suspected, especially in the immunocompromised, then a broad-spectrum antipseudomonal beta-lactam antibiotic should be added. Examples include ceftazidime and meropenem.
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