Cases
A 25 y-o-W with recurrent cystitis, is getting better on d#2 of nitrofurantoin, urine is growing Klebsiella Pneumoniae +ESBL, intermediate sensitivity to Nitrofurantoin.
What is the most appropriate recommendation?
A- Finish 3 more days of nitrofurantoin
B- Give 3 grams of fosfomycin po once
C- Give 3 days of IV carbapenem
D- Give 5 days of IV carbapenem
E- Give a 10 days course of nitrofurantoin
Which of the following enzymes is NOT a carbapenemase?
A- New Delhi metallo-β-lactamases (NDMs)
B- OXA-48-like
C- Verona integron-encoded metallo-β-lactamases (VIMs)
D- CTX-M
E- Imipenem-hydrolyzing metallo-β-lactamases (IMPs)
Which antibiotic has the least activity against Streptococcus pneumoniae ?
A.Ceftaroline
B.Tygacycline
C.Levofloxacin
D.Ciprofloxacin
E.Ceftriaxone
A 54 y-o-W with pyelonephritis secondary to E. Coli resistant to Ceftriaxone.
With history of penicillin allergy, documented 20 years ago as a generalized, pruritic rash, that started 48 hours while receiving oral amoxicillin/clavulanate for cystitis.
What would be the most appropriate treatment?
A- Piperacillin/Tazobactam
B- Aztreonam
C- Ertapenem
D- Gentamicin
E- Nitrofurantoin
Which of the following resistance are NOT of current concern ?
A.Neisseria gonorrhea resistance to ceftriaxone
B.Streptococcus pyogenes resistance to ceftriaxone
C.Salmonella spp. Resistance to ceftriaxone
D.Enterococcus faecalis resistance to vancomycin
E.Klebsiella pneumoniae resistance to carbapenem
What is the preferred therapy for Stenotrophomonas maltophilia severe infection?
A- Meropenem
B- TMP/SMZ+Minocycline
C- Cefiderocol
D- Levofloxacin
E- Aztreonam
Which antibiotic is least likely to cause CDI?
A.Eravacycline
B.Ampicillin
C.Azithromycin
D.Clindamycin
E.ciprofloxacin
Which antibiotic has the best activity against Pseudomonas aeruginosa ?
A.Cefepime
B.Meropenem
C.Cetolozane-tazobactam
D.Ceftazidime-avibactam
E.Plazomicin
A 65 y-o-M ESKD, HDD, with E. Coli ESBL CLABSI.
E. Coli otherwise sensitive to ertapenem, TMP/SMZ, ciprofloxacin, tetracycline. Resistant to gentamicin.
Line removed, responding to IV meropenem day#3, afebrile, asymptomatic, BS well controlled.
What would be the most appropriate action?
A- Finish 14 days of Meropenem IV
B- Switch to oral Moxifloxacin for another 4 to 5 days.
C-Switch to oral TMP/SMZ to finish a 14 days course of therapy
D- Switch to IV doxycycline to decrease chance of CDI
E- Add gentamicin after HD, for synergy with meropenem.
Which of the following does NOT contribute at decreasing bacterial resistance ?
A.Hand hygiene
B.Combination antibiotic therapy
C.High dose of antibiotics
D.Longer duration of therapy
E.Antibiotic stewardship program
Which of the following has the least activity against CRE ?
A- Cetolozane-tazobactam
B- Ceftazidime-avibactam
C- Meropenem-vaborbactam
D- Imipenem-cilastatin-relebactam
E- Cefiderocol
Which antibiotic is least likely to cause fixed drug eruption?
A.Minocycline
B.Ceftriaxone
C.Gentamicin
D.TMP/SMZ
E.Clarithromycin
Which antibiotic is more likely to cause acute pancreatitis?
A.Cefotaxime
B.Ciprofloxacin
C.Metronidazole
D.Imipenem-cilastatin
E.Tigecycline
A 55 y-o-W with recurrent UTIs, has dysuria, frequency, and hematuria for 2 days, getting worse.
Denies fever, chills, flank pain.
Lab: normal WBC count and renal function. Urine C&S + for KPC resistant to Meropenem, cefepime, ceftriaxone, TMP/SMZ, ciprofloxacin and gentamicin.
What’s the best treatment option?
A- Nitrofurantoin po for 14 days.
B- Levofloxacin po for 5 days.
C- Polymixin B IV for 3 days.
D- Doxycycline po for 7 days.
E- Plazomycin 15mg/Kg IV 1 dose.
Which of the following antibiotic activity is NOT time-dependent ?
A.Ceftaroline
B.Ceftriaxone
C.Plazomicin
D.Aztreonam
E.Ertapenem
Which antibiotic has the least activity against MRSA?
A.Linezolid
B.Dalbavancin
C.Ceftaroline
D.Clindamycin
E.Quinupristin/Dalfopristin
Which antibiotic has the least activity against Bacteroides fragilis ?
A.Clindamycin
B.Metronidazole
C.Ertapenem
D.Piperacillin/tazobactam
E.Ampicillin/sulbactam
A 75 y-o-M post-CABG with respiratory failure, on mechanical ventilation.
Has fever, leukocytosis, increased PCT, and a new lung infiltrate.
Not responding to Meropenem+Linezolid.
Tracheal aspirate growing Acinetobacter baumanni resistant to carbapenem. (CRAB)
What is the best approach for his therapy?
A- High dose extended infusion of Doripenem
B- Ampicillin/sulbactam+Minocycline
C- Levofloxacin+TMP/SMZ
D- Piperacillin/Tazobactam+Amikacin
E- Cefiderocol
Which of the following antibiotic activity is concentration-dependent ?
A.Cefepime
B.Amikacin
C.Cefiderocol
D.Ceftaroline
E.TMP/SMZ
Which set of bacteria would you treat with Cefepime rather than Ceftriaxone, because inducible Amp C production?
A- Hafnia alvei, Citrobacter youngae, Klebsiella Pneumoniae
B- Enterobacter cloace, Yersinia enterocolitica, Providencia spp
C- Serratia marcescens, Morganella morganii, Klebsiella aerogenes
D- Klebsiella aerogenes, Citrobacter freundii, Enterobacter cloace
E- Providencia spp, Proteus mirabilis, Pseudomonas Aeruginosa