Which approach is appropriate for management of catheter-associated infection in very ill patients?

• A. Narrow-spectrum penicillin monotherapy
• B. Broad-spectrum beta-lactamase and MRSA coverage (imipenem plus vancomycin)
• C. Azithromycin alone
• D. No antibiotics; remove catheter

Answer: (B)

In very ill patients with a catheter-associated infection, the priority is rapid broad empirical antibiotic coverage that includes MRSA and resistant Gram-negative organisms, because the infection can progress quickly and culture results may be delayed. The combination of a carbapenem and vancomycin achieves that breadth: imipenem provides potent activity against many Gram-negative rods (including Pseudomonas) and anaerobes, while vancomycin covers MRSA and other resistant Gram-positive cocci. This approach targets a wide range of potential pathogens until specific results guide de-escalation. Relying on a narrow-spectrum agent would miss MRSA and many Gram-negatives; azithromycin alone lacks sufficient coverage for severe catheter-related infection; and removing the catheter without antibiotics would not control a systemic infection. Source control is important and antibiotics are essential in parallel.