Abstract Introduction There are approximately 30,000 catheter-related bloodstream infections (CRBSI) reported in the U.S. annually, with 13% of those cases attributed to staphylococcus aureus. These infections are associated with substantial morbidity, mortality, and cost. We report a case of persistent methicillin-resistant staphylococcus aureus (MRSA) bacteremia in a woman who developed an infected atrial thrombus after placement of a new central venous catheter before source control was achieved. Description A 34-year-old woman with a history of end-stage renal disease on home hemodialysis was admitted to the ICU with septic shock secondary to MRSA bacteremia. A positive catheter tip culture from her tunneled dialysis catheter confirmed the source of the infection. The catheter was promptly removed, however, due to anuric uremia, the patient had to be resumed on renal replacement therapy. A non-tunneled central venous catheter was placed within 24 hours of presentation, while the patient was on empiric antibiotics. Repeat cultures remained positive at hospital day 4, and a transthoracic echocardiogram had been unremarkable. Subsequently, a transesophageal echocardiogram was obtained, which demonstrated a 5 x 2 cm, mobile, snake-like lesion in the right atrium. This was emanating from the superior vena cava and was determined to be an infected thrombus attached to the newly placed catheter. Cardiovascular surgery was consulted, and the patient underwent percutaneous thrombectomy with Angio Vac. The following blood cultures were negative, and the IV antibiotics were continued for a total of 4 weeks, with resolution of the infection. Discussion Current guidelines recommend a new central venous catheter should be placed at least 48 hours after the first negative blood culture in CRBSI. A TEE is also recommended for persistent bacteremia after 72 hours of initiating appropriate antimicrobials and catheter removal. This case highlights the importance of a universal management plan in CRBSI. A transthoracic echocardiogram was unable to detect the substantial atrial thrombus, and if protocol had not been followed, definitive source control would have been delayed, placing the patient at high risk for complications and mortality. This abstract is funded by: None
Rizvee et al. (Fri,) studied this question.