1. What is the most likely diagnosis?
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
The current recommendation by NICE and the BNF on the treatment of septicaemia related to vascular catheters is to use vancomycin first-line.
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.
Header image used on licence from Shutterstock