Match each device-associated clinical scenario with the most appropriate device management and therapeutic strategy based on current infectious disease and antimicrobial stewardship guidelines.
- A patient with a long-term tunneled hemodialysis catheter develops uncomplicated catheter-related bloodstream infection due to coagulase-negative Staphylococcus.Attempt catheter salvage using systemic antimicrobial therapy combined with antibiotic lock therapy
- A patient with a short-term central venous catheter in the intensive care unit develops catheter-related bloodstream infection due to Candida glabrata.Remove the device immediately and initiate targeted systemic antimicrobial therapy; catheter salvage is contraindicated
- A patient with a urinary catheter placed three days ago has cloudy urine and >100,000 CFU/mL of Escherichia coli, but lacks fever, suprapubic pain, or other systemic symptoms.Remove the device if no longer clinically indicated and withhold targeted antimicrobial therapy
- A patient with a peripheral intravenous catheter develops localized pain, erythema, and a palpable venous cord at the insertion site without fever.Remove the device and apply warm compresses; systemic antimicrobial therapy is generally not indicated
Answer
The long-term catheter with coagulase-negative Staphylococcus matches to attempting catheter salvage with lock therapy. The short-term catheter with Candida glabrata matches to immediate removal with systemic therapy. The urinary catheter with asymptomatic bacteriuria matches to removing the device without targeted antibiotics. The peripheral IV with phlebitis matches to removal and warm compresses without antibiotics.
The correct matches accurately apply principles of infection control and antimicrobial stewardship. Uncomplicated coagulase-negative staphylococcal CLABSI in long-term catheters allows for salvage attempts with lock therapy to preserve access. Conversely, Candida glabrata CLABSI requires immediate removal due to biofilm resilience and metastatic risk. Asymptomatic bacteriuria (positive culture without systemic symptoms) requires catheter removal without antibiotics to prevent resistance. Finally, peripheral intravenous phlebitis is typically a sterile inflammation managed with supportive care and device removal.
Step-by-Step Solution
Key Concept
Management of device-associated conditions requires distinguishing between sterile inflammation, colonization, and true infection, while balancing the need to preserve vital access against the risk of metastatic complications.