A dialysis patient develops Staphylococcus aureus bacteraemia attributed to a tunnelled central line. The minimum duration of antibiotic treatment and the drug of choice (MRSA confirmed) are:
- A Vancomycin for ≥4–6 weeks if complicated; line should be removed; echocardiogram to exclude endocarditis ✓
- B Vancomycin for 2 weeks; line removal is optional
- C Oral co-trimoxazole for 4 weeks after line removal
- D Vancomycin for 14 days regardless of complications; line can stay
Correct answer: A. Vancomycin for ≥4–6 weeks if complicated; line should be removed; echocardiogram to exclude endocarditis
Explanation
IDSA guidelines for MRSA CLABSI: catheter removal is essential; echocardiography is mandatory to exclude endocarditis given high risk; uncomplicated bacteraemia (no endocarditis, no implanted hardware, negative follow-up blood cultures by day 2–4) requires vancomycin for at least 2 weeks, but complicated cases (endocarditis, deep-seated infection, persistent bacteraemia) require 4–6 weeks of vancomycin. Oral therapy is not appropriate for S. aureus bacteraemia. Vancomycin AUC/MIC-guided dosing is now the monitoring standard.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
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