Afebrile, (likely fungal) bloodstream infections?
Courtesy of an exceptionally lazy and incopentent home health nurse, I had to have an infected PICC line removed Sunday (today is Thursday). The skin around the insertion site appears to be riddled with a fungal infection (does seem to be getting better with topical antifungals). I am concerned about possible bloodstream infection (brownish yellow “goo” all along the line when she pulled it out). My temperature has not been over 99.5 since it was pulled. Is a catheter-related BSI possible in the absence of high fever? If so, would lit likely present itself immediatiely, or could it take several days?
TIA,
~M~
p.s. Had PICC inserted in opposite arm the next day.
PICC is for delivery of IV antibiotics for the treatment of Lyme disease.
Thank you so much, Gabuchila. That helps me out quite a bit. Hopefully, this did not turn into a BSI. For some reason, this second PICC really hurts (arm very achey and no clue why so achey under my right rib cage). I’m not having very good luck with PICCs thus far, to say the least!
You could have one of three different things:
1. Site infection
2.Catheter colonization/ contamination: In this case the blood cultures would be negative but the cath tip would be positive.
In this case you don’t need antifungals or antibiotics, because the infection is in the catheter but not in the blood stream and the cath is already removed.
3. Catheter related candidemia (in case you actually have fungal infection) or bacteremia if it’s a bacteria. In this case, both the blood stream and the catheter are positive. You would need intravenous antibiotics for 2 weeks after the catheter is removed.
For any of these circumstances you don’t need to have a fever, although a fever would be more suggestive of bloodstream infection, the opposite is not necessarily true.
Once the catheter is removed, if you don’t have bacteremia/ candidemia, you won’t get it ( unless, in your case, the 2nd PICC got infected).
In summary, you need to have blood cultures drawn if your doctor suspects candidemia, and the tip should have been sent for culture.
Most of the time, though, the infection is localized and gone with the catheter