A purulent drainage was obtained on left shoulder arthrocentesis and a positive culture for P. aeruginosa (sensitive to both gentamicin and ceftazidime-avibactam) was present. A relation between the actual complaints with the previous CVC infection was considered and a B-mode ultrasound imaging was obtained using a 5.0 MHz curvilinear probe (video 1). It revealed a swinging vegetation adjacent to the tip of catheter, suggestive of a bacterial biofilm. Both blood and CVC cultures revealed the same bacterial growth as in arthrocentesis.
Reference:Monteiro Dias L, Carvalho R, Oliveira AA, Costa RM. Pseudomonas aeruginosa bacteraemia: the role of ultrasound to confirm vascular access infection. BMJ Case Rep. 2021 Jan 11;14(1):e240376. doi: 10.1136/bcr-2020-240376. PMID: 33431482.