In reply: Managing bloodstream infections

In Reply: We thank Dr. Dias for his careful read of our article, “Managing bloodstream infections in patients who have short-term central venous catheters,” and we acknowledge that he is correct to point out that, by definition, severe sepsis is sepsis associated with organ dysfunction, hypoperfusion, or hypotension. Given this, he is correct that patients with severe sepsis should be categorized in the “seriously ill” patient group in our Figure 1.

In effect, however, the recommendations for patients in the “high-risk-factor” group are the same as the recommendations for the “seriously ill” patient group, which are to remove the catheter, draw at least two sets of blood cultures with at least one from a peripheral vein, and start empiric antibiotic therapy.