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? 7. Long-term catheters should be removed from patients with CRBSI
A. Catheter cultures should be obtained routinely. associated with infections due to which of the following organisms?
B. Qualitative broth culture of catheter tips is not recommended. Select all that apply.
C. Growth of >102 cfu from a catheter by quantitative broth culture I. S. aureus
reflects catheter colonization. II. Gram negative bacilli
D. When catheter infection is suspected and there is a catheter exit III. P. aeruginosa
site exudate, swab the drainage to collect specimens for culture IV. Fungi
and Gram staining. V. Mycobacteria
E. All of the above VI. Enterococcus
A. All
2. A definitive diagnosis of CRBSI requires which of the following? B. All except II
A. Same organism grows from at least one percutaneous blood C. All except II and VI
culture and from a culture of the catheter tip. D. I and IV only
B. Two blood samples be drawn (one from a catheter hub and the
other from a peripheral vein) that, when cultured, meet CRBSI 8. Short-term catheters should be removed from patients with CRBSI
criteria for quantitative blood cultures or DTP associated with infections due to which of the following organisms?
C. Two quantitative blood cultures of samples obtained through 2 Select all that apply.
catheter lumens in which the colony count for the blood sample I. S. aureus
drawn through one lumen is at least 3-fold greater than the colony II. Enterococci
count for the blood sample obtained from the second lumen III. Gram negative bacilli
D. All of the above IV. Fungi
V. Mycobacteria
3. In addition to coverage for gram-positive pathogens, empirical therapy for VI. Bacillus
suspected CRBSI involving femoral catheters in critically ill patients A. All
should include coverage for: B. All except II
A. Gram-negative bacilli C. All except VI
B. Candida species D. All except II and VI
C. Neisseria organisms
D. A and B 9. Which of the following is true regarding CRBSI associated with less
E. All of the above virulent microbes that are difficult to eradicate?
A. This includes Bacillus and Micrococcus species.
4. Empirical therapy for suspected catheter-related candidemia should be B. It includes Propionibacteria.
used for septic patients with which of the following risk factors? Select all C. For long-term and short-term CRBSI due to these organisms,
that apply. catheters should generally be removed after blood culture
I. total parenteral nutrition contamination is ruled out on the basis of multiple positive culture
II. prolonged use of broad-spectrum antibiotics results, with at least 1 blood culture sample drawn from a
III. hematologic malignancy peripheral vein
IV. receipt of bone marrow or solid-organ transplant D. All of the above
V. femoral catheterization E. B and C only
VI. colonization due to Candida species at multiple sites
A. All 10. A catheterized patient has a single positive blood culture that grew
B. All except V methicillin-resistant Staphylococcus epidermidis after 17 hours of
C. I, II, and VI only incubation. What is the best next thing to do?
D. I and VI only A. Obtain additional cultures of blood samples through the suspected
catheter and from a peripheral vein
5. In adult patients with CRBSI who are found to have osteomyelitis, how B. Start Vancomycin
long should the antibiotics be given? C. Recommend catheter removal
A. 2-3 weeks D. Do nothing, consider it a contaminant.
B. 4-6 weeks
C. 6-8 weeks 11. A 60/M CKD patient was admitted for fever and chills during dialysis.
D. 8-12 weeks Blood CS from the peripheral site grew methicillin-resistant S. hominis
after 19 hours of incubation. The same organism grew after 12 hours
6. Long-term catheters should be removed from patients with CRBSI from the blood specimen taken from the right IJ catheter. You started him
associated with which of the following conditions? Select all that apply. on Vancomycin. IJ catheter was removed. How long should you give the
I. severe sepsis antibiotic?
II. suppurative thrombophlebitis A. 3 – 5 days
III. endocarditis B. 5 – 7 days
IV. bloodstream infection that continues despite >72 h of antimicrobial C. 7 – 14 days
therapy to which the infecting microbes are susceptible D. 10 – 14 days
A. All
B. All except I
C. All except IV
D. II and III only
12. You are suspecting CRBSI on 56/M dialytic patient with IJ catheter. You 19. In general, patients with S. aureus CRBSI should receive antibiotics for
requested for blood CS x 2 sites, however, a peripheral sample cannot how long?
be obtained. What should you do? A. 1-2 weeks
A. Insist that a peripheral blood sample be cultured to ascertain B. 2-4 weeks
diagnosis of CRBSI. C. 4-6 weeks
B. Request blood samples be drawn during hemodialysis from D. 6-8 weeks
bloodlines connected to the central venous catheter.
C. Treat as CRBSI 20. A shorter duration of antimicrobial therapy can be considered for patients
D. None of the above with S. aureus CRBSI in which of the following conditions? Select all that
apply.
13. In a symptomatic hemodialysis patient, when a peripheral blood sample I. If the patient is not diabetic
cannot be obtained, no other catheter is in place from which to obtain an II. If the patient is not immunosuppressed
additional blood sample, there is no drainage from the insertion site III. If the infected catheter is removed
available for culture, and there is no clinical evidence for an alternate IV. If the patient has no prosthetic intravascular device
source of infection, the best thing to do is: V. If there is no evidence of IE on TTE
A. Continue antimicrobial therapy for possible CRBSI VI. If there is no evidence of suppurative thrombophlebitis
B. Discontinue antibiotics as there is no supporting microbiologic VII. If fever and bacteremia resolve within 4 days after initiation of
evidence for CRBSI appropriate antibiotic/s
C. Insert central venous catheter and collect blood specimen for VIII. If there is no evidence of metastatic infection
culture A. All
D. A and C are both correct B. All except V
C. All except VII
14. A 60/M CKD patient was admitted for fever and chills during dialysis. D. All except V and VII
Blood CS from the peripheral site grew S. aureus after 19 hours of E. All except I, V, and VII
incubation. The same organism grew after 12 hours from the blood
specimen taken from the right IJ catheter. The patient was referred to 21. Patients with S. aureus CRBSI who are being considered for a shorter
TCVS for re-insertion of the IJ catheter, however, there no alternative duration of therapy should have a transesophageal echocardiograph
sites are available for catheter insertion, what is the best thing to do? obtained. It should be done at least how many days after the onset of
A. Mock the competency of the TCVS resident for not being able to bacteremia?
insert a central line. A. Immediately to rule out IE
B. Refer the case to the senior TCVS resident. B. 3-5 days
C. Recommend to exchange the infected catheter over a guidewire. C. 5-7 days
D. Trial of salvage therapy, give the antibiotic via the infected D. 7-14 days
catheter.
22. Patients whose catheter tip grows S. aureus but whose initial peripheral
15. In the above case, you started Vancomycin as empiric therapy. The blood cultures have negative results should receive antibiotics for how
sensitivity result showed methicillin-susceptible S. aureus. You should: long?
A. Shift Vancomycin to Cefazolin A. 3-5 days
B. Shift Vancomycin to Linezolid B. 5-7 days
C. Continue Vancomycin C. 7-14 days
D. Shift Vancomycin to Cloxacillin D. Antibiotics not indicated

16. A 55/M CKD patient was admitted for fever and chills during dialysis. 23. What is the drug of choice for ampicillin-resistant Enterococcus CRBSI?
Blood CS from the peripheral site grew Enterobacter cloacae after 19 A. High-dose ampicillin + Gentamicin
hours of incubation. The same organism grew after 12 hours from the B. Vancomycin
blood specimen taken from the right IJ catheter. What will you do? C. Linezolid
A. Initiate empiric IV vancomycin and ertapenem D. Daptomycin
B. Recommend immediate catheter removal E. Ampicillin + Gentamicin
C. Start Ertapenem
D. Recommend line holiday once renally optimized 24. TEE should be done for patients with CRBSI who have the following
conditions except:
17. A 55/M CKD patient was admitted for fever and chills during dialysis. A. Prosthetic heart valve
Blood CS from the peripheral site grew E. cloacae after 19 hours of B. Pacemaker or implantable defibrillator
incubation. The same organism grew after 12 hours from the blood C. Persistent bacteremia or fungemia and/or fever >3 days after
specimen taken from the right IJ catheter. You started the appropriate IV initiation of appropriate antibiotic therapy and catheter removal
antibiotics. After 2 days, fever and chills resolved. PE and workups did D. None of the above
not show metastatic foci of infection. What will you do?
A. Recommend catheter removal and reinsertion to another 25. Which of the following statements is false?
anatomical site A. Catheters should be removed in cases of CRBSI due to Candida
B. Recommend to exchange the infected catheter over a guidewire species
C. Retain the catheter and do antibiotic lock therapy after each B. For patients with candidemia and a short-term CVC for whom no
dialysis session source of candidemia is obvious, the catheter should be removed
D. B and C are correct and the catheter tip sent for culture
C. Antifungal therapy is recommended for all cases of CRBSI due to
18. Which of the following statements is false? Candida species, including cases in which clinical manifestations of
A. It is not necessary to confirm negative culture results before infection and/or candidemia resolve after catheter withdrawal and
guidewire exchange of a catheter for a patient with hemodialysis- before initiation of antifungal therapy
related CRBSI if the patient is asymptomatic. D. None of the above
B. Surveillance blood cultures should be obtained 1 week after
completion of an antibiotic course for CRBSI if the catheter has
been retained Prepared by:
C. If surveillance blood cultures have positive results, the catheter Reña, MD
should be removed and a new, long-term dialysis catheter should
be placed after additional blood cultures are obtained that have
negative results -Nothing follows-
D. A and B are wrong statements
E. None of the above