IDS FELLOWS’ WEEKLY EXAM

IDSA CRBSI Guidelines

January 9, 2023

Name: ____________________________________________________ Signature: _________________________ Year Level: ______

1. Which of the following statements regarding catheter culture is false?

A. Catheter cultures should be obtained routinely.
B. Qualitative broth culture of catheter tips is not recommended.
C. Growth of >102 cfu from a catheter by quantitative broth culture reflects catheter colonization.
D. When catheter infection is suspected and there is a catheter exit site exudate, swab the drainage to collect specimens for culture and Gram staining.
E. All of the above

2. A definitive diagnosis of CRBSI requires which of the following?

A. Same organism grows from at least one percutaneous blood culture and from a culture of the catheter tip.
B. Two blood samples be drawn (one from a catheter hub and the other from a peripheral vein) that, when cultured, meet CRBSI criteria for quantitative blood
cultures or DTP
C. Two quantitative blood cultures of samples obtained through 2 catheter lumens in which the colony count for the blood sample drawn through one lumen is at
least 3-fold greater than the colony count for the blood sample obtained from the second lumen
D. All of the above

3. In addition to coverage for gram-positive pathogens, empirical therapy for suspected CRBSI involving femoral catheters in critically ill patients should include
coverage for:
A. Gram-negative bacilli
B. Candida species
C. Neisseria organisms
D. A and B
E. All of the above
4. Empirical therapy for suspected catheter-related candidemia should be used for septic patients with which of the following risk factors? Select all that apply.
I. total parenteral nutrition
II. prolonged use of broad-spectrum antibiotics
III. hematologic malignancy
IV. receipt of bone marrow or solid-organ transplant
V. femoral catheterization
VI. colonization due to Candida species at multiple sites
A. All
B. All except V
C. I, II, and VI only
D. I and VI only

5. In adult patients with CRBSI who are found to have osteomyelitis, how long should the antibiotics be given?
A. 2-3 weeks
B. 4-6 weeks
C. 6-8 weeks
D. 8-12 weeks

6. Long-term catheters should be removed from patients with CRBSI associated with which of the following conditions? Select all that apply.
I. severe sepsis
II. suppurative thrombophlebitis
III. endocarditis
IV. bloodstream infection that continues despite >72 h of antimicrobial therapy to which the infecting microbes are susceptible
A. All
B. All except I
C. All except IV
D. II and III only

7. Long-term catheters should be removed from patients with CRBSI associated with infections due to which of the following organisms? Select all that apply.
I. S. aureus
II. Gram negative bacilli
III. P. aeruginosa
IV. Fungi
V. Mycobacteria
VI. Enterococcus
A. All
B. All except II
C. All except II and VI
D. I and IV only
8. Short-term catheters should be removed from patients with CRBSI associated with infections due to which of the following organisms? Select all that apply.
I. S. aureus
II. Enterococci
III. Gram negative bacilli
IV. Fungi
V. Mycobacteria
VI. Bacillus
A. All
B. All except II
C. All except VI
D. All except II and VI

9. Which of the following is true regarding CRBSI associated with less virulent microbes that are difficult to eradicate?
A. This includes Bacillus and Micrococcus species.
B. It includes Propionibacteria.
C. For long-term and short-term CRBSI due to these organisms, catheters should generally be removed after blood culture contamination is ruled out on the
basis of multiple positive culture results, with at least 1 blood culture sample drawn from a peripheral vein
D. All of the above
E. B and C only

10. A catheterized patient has a single positive blood culture that grew methicillin-resistant Staphylococcus epidermidis after 17 hours of incubation. What is the best
next thing to do?
A. Obtain additional cultures of blood samples through the suspected catheter and from a peripheral vein
B. Start Vancomycin
C. Recommend catheter removal
D. Do nothing, consider it a contaminant.

11. A 60/M CKD patient was admitted for fever and chills during dialysis. Blood CS from the peripheral site grew methicillin-resistant S. hominis after 19 hours of
incubation. The same organism grew after 12 hours from the blood specimen taken from the right IJ catheter. You started him on Vancomycin. IJ catheter was
removed. How long should you give the antibiotic?
A. 3 – 5 days
B. 5 – 7 days
C. 7 – 14 days
D. 10 – 14 days

12. You are suspecting CRBSI on 56/M dialytic patient with IJ catheter. You requested for blood CS x 2 sites, however, a peripheral sample cannot be obtained. What
should you do?
A. Insist that a peripheral blood sample be cultured to ascertain the diagnosis of CRBSI.
B. Request blood samples be drawn during hemodialysis from bloodlines connected to the central venous catheter.
C. Treat as CRBSI
D. None of the above
13. In a symptomatic hemodialysis patient, when a peripheral blood sample cannot be obtained, no other catheter is in place from which to obtain an additional blood
sample, there is no drainage from the insertion site available for culture, and there is no clinical evidence for an alternate source of infection, the best thing to do is:
A. Continue antimicrobial therapy for possible CRBSI
B. Discontinue antibiotics as there is no supporting microbiologic evidence for CRBSI
C. Insert central venous catheter and collect blood specimen for culture
D. A and C are both correct

(BONUS. The case should have stated that there is a positive result of culture performed on the blood sample obtained from the catheter)

14. A 60/M CKD patient was admitted for fever and chills during dialysis. Blood CS from the peripheral site grew S. aureus after 19 hours of incubation. The same
organism grew after 12 hours from the blood specimen taken from the right IJ catheter. The patient was referred to TCVS for re-insertion of the IJ catheter,
however, there no alternative sites are available for catheter insertion, what is the best thing to do?
A. Mock the competency of the TCVS resident for not being able to insert a central line.
B. Refer the case to the senior TCVS resident.
C. Recommend to exchange the infected catheter over a guidewire.
D. Trial of salvage therapy, give the antibiotic via the infected catheter.

15. In the above case, you started Vancomycin as empiric therapy. The sensitivity result showed methicillin-susceptible S. aureus. You should:
A. Shift Vancomycin to Cefazolin
B. Shift Vancomycin to Linezolid
C. Continue Vancomycin
D. Shift Vancomycin to Cloxacillin

16. A 55/M CKD patient was admitted for fever and chills during dialysis. Blood CS from the peripheral site grew Enterobacter cloacae after 19 hours of incubation. The
same organism grew after 12 hours from the blood specimen taken from the right IJ catheter. What will you do?
A. Initiate empiric IV vancomycin and ertapenem
B. Recommend immediate catheter removal
C. Start Ertapenem
D. Recommend line holiday once renally optimized

17. A 55/M CKD patient was admitted for fever and chills during dialysis. Blood CS from the peripheral site grew E. cloacae after 19 hours of incubation. The same
organism grew after 12 hours from the blood specimen taken from the right IJ catheter. You started the appropriate IV antibiotics. After 2 days, fever and chills
resolved. PE and workups did not show metastatic foci of infection. What will you do?
A. Recommend catheter removal and reinsertion to another anatomical site
B. Recommend to exchange the infected catheter over a guidewire
C. Retain the catheter and do antibiotic lock therapy after each dialysis session
D. B and C are correct
18. Which of the following statements is false?
A. It is not necessary to confirm negative culture results before guidewire exchange of a catheter for a patient with hemodialysis-related CRBSI if the patient is
asymptomatic.
B. Surveillance blood cultures should be obtained 1 week after completion of an antibiotic course for CRBSI if the catheter has been retained
C. If surveillance blood cultures have positive results, the catheter should be removed and a new, long-term dialysis catheter should be placed after additional
blood cultures are obtained that have negative results
D. A and B are wrong statements
E. None of the above

19. In general, patients with S. aureus CRBSI should receive antibiotics for how long?
A. 1-2 weeks
B. 2-4 weeks
C. 4-6 weeks
D. 6-8 weeks

20. A shorter duration of antimicrobial therapy can be considered for patients with S. aureus CRBSI in which of the following conditions? Select all that apply.
I. If the patient is not diabetic
II. If the patient is not immunosuppressed
III. If the infected catheter is removed
IV. If the patient has no prosthetic intravascular device
V. If there is no evidence of IE on TTE
VI. If there is no evidence of suppurative thrombophlebitis
VII. If fever and bacteremia resolve within 4 days after initiation of appropriate antibiotic/s
VIII. If there is no evidence of metastatic infection
A. All
B. All except V
C. All except VII
D. All except V and VII
E. All except I, V, and VII
21. Patients with S. aureus CRBSI who are being considered for a shorter duration of therapy should have a transesophageal echocardiograph obtained. It should be
done at least how many days after the onset of bacteremia?
A. Immediately to rule out IE
B. 3-5 days
C. 5-7 days
D. 7-14 days

22. Patients whose catheter tip grows S. aureus but whose initial peripheral blood cultures have negative results should receive antibiotics for how long?
A. 3-5 days
B. 5-7 days
C. 7-14 days
D. Antibiotics not indicated

23. What is the drug of choice for ampicillin-resistant Enterococcus CRBSI?

A. High-dose ampicillin + Gentamicin
B. Vancomycin
C. Linezolid
D. Daptomycin
E. Ampicillin + Gentamicin

24. TEE should be done for patients with CRBSI who have the following conditions except:
A. Prosthetic heart valve
B. Pacemaker or implantable defibrillator
C. Persistent bacteremia or fungemia and/or fever >3 days after initiation of appropriate antibiotic therapy and catheter removal
D. None of the above

25. Which of the following statements is false?

A. Catheters should be removed in cases of CRBSI due to Candida species
B. For patients with candidemia and a short-term CVC for whom no source of candidemia is obvious, the catheter should be removed and the catheter tip sent
for culture
C. Antifungal therapy is recommended for all cases of CRBSI due to Candida species, including cases in which clinical manifestations of infection and/or
candidemia resolve after catheter withdrawal and before initiation of antifungal therapy
D. None of the above
 Prepared by:
Reña, MD

-Nothing follows-