Clinical Presentation & Protocol
Patient Usually Complains Of
Patient is a chronic hemodialysis dependent individual presenting with fever, chills, and rigors occurring during or shortly after dialysis session. Catheter site noted to have erythema, purulent discharge, or tenderness. No history of recent antibiotic use. Review of systems positive for malaise and diaphoresis.
Clinical Examination Findings
Patient appears acutely ill, febrile (T: __°C), tachycardic (HR: __ bpm), and hypotensive (BP: __/__ mmHg). Examination of the tunneled/non-tunneled catheter site reveals localized inflammation, induration, and purulent exudate at the exit site. No evidence of tunnel tract infection or cuff abscess.
Treatment Protocol
Immediate blood cultures (peripheral and catheter) obtained. Empiric IV antibiotics initiated covering MRSA and Gram-negative organisms (e.g., Vancomycin + Ceftazidime/Gentamicin). Catheter removal/exchange scheduled pending clinical stability and microbiology results. Monitor for signs of metastatic infection.