BOF: 5
A 32-year-old female patient
has had multiple resections of the bowel on account of recurrent Crohn's
disease. This has resulted in intestinal failure and she is dependent on home
parenteral nutrition.
She has a Broviac catheter inserted for central venous access. She presents
with fever accompanied by chills and rigors.
No physical signs are demonstrable.
Cultures taken both centrally and peripherally demonstrate the presence of
methicillin-sensitive Staphylococcus aureus.
Your next course of action would be
a) Treatment
with intravenous vancomycin for 14 days followed by repeat cultures
b) Treatment
with intravenous teicoplanin for 14 days followed by repeat cultures
c) Determine
the antibiotic sensitivity prior to commencing antibiotic treatment
d) Do
not use the intravenous line until the infection has been successfully
eradicated.
e) Remove the intravenous line
Answer
e)
One of the main
complications of parenteral nutrition is infection of the central line.
Educating the patient and carers may reduce this.
However, line infections do occur and infection with Staphylococcus aureus and
Candida are indications for line removal.
