A post-operative patient on TPN develops fever, elevated blood glucose, and hypertriglyceridaemia. His central line was placed 12 days ago. Blood cultures grow Candida albicans. The most appropriate action regarding the central venous catheter (CVC) is:
- A Remove the CVC immediately and insert a new CVC at a different site ✓
- B Add antifungal coverage and continue the existing CVC with line care
- C Replace the CVC over a guidewire and send tip for culture
- D Treat with systemic antifungals only; CVC removal is not necessary for Candida
Correct answer: A. Remove the CVC immediately and insert a new CVC at a different site
Explanation
Catheter-related Candida bloodstream infection mandates prompt removal of the infected CVC (do not exchange over a guidewire, which seeds the new catheter) and insertion at a fresh site, combined with systemic antifungal therapy (echinocandin first-line: caspofungin or micafungin) for at least 14 days after the last positive blood culture and resolution of symptoms. Guidewire exchange is contraindicated in fungal line infection as it re-inoculates the new catheter. Ophthalmological examination is required to exclude Candida endophthalmitis.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.