A patient develops signs of sepsis. She has had a central line in situ for the past ten days. There is erythema surrounding the catheter insertion site.

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
2. What is the first-line antibacterial agent of choice for this diagnosis?
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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.

3. Which type of antibacterial agent should be added if the patient is known to be immunocompromised? Give an example.
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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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