Resistance
Spiraling Empiricism
Pharmacotherapy
Microbiology
Potpourri
100
The SPICE-M organisms make inducible B-lactamases (Amp-C). What are the SPICE-M organisms?
Serratia Providencia Indole + Proteus (vulgaris) Citrobacter Enterobacter Morganella
100
Based on our 50/50 rate of MSSA:MRSA infections, what would be an appropriate regimen to discharge a patient from the ED on who presented with purulent cellulitis?
Cephalexin + Doxycycline Cephalexin + sulfa/TMP Clindamycin + Doxycycline (allergy to b-lactam) Clindamycin + sulfa/TMP (allergy to b-lactam)
100
Name 2 classes of antimicrobials that exhibit "Concentration-Dependent Killing"
Aminoglycosides Fluoroquinolones
100
What sub-species of Candida are typically susceptible to fluconazole?
Candida albicans Candida parapsilosis Candida tropicalis Candida lusitaniae Candida guilliermondii
100
Name 3 different 'atypical' microbes
Mycoplasma pneumoniae Chlamydophilia pneumonia Legionella pneumophilia Bordetella pertussis (whooping cough)
200
You receive a page that a patient's blood culture isolated an ESBL (extended spectrum beta-lactamase) producing organism. What is the treatment of choice for this infection?
Carbapenems (imipenem, meropenem or ertapenem)
200
What is the recommended empiric meningitis regimen for a 70 year old male patient?
Vancomycin Ceftriaxone Ampicillin Dexamethasone (+ if strep pneumo)
200
Name 3 classes of agents that exhibit "Time-Dependent Killing"
B-lactams Vancomycin Lincosamides/Macrolides
200
Your diabetic patient presents with a non-healing ulcer. He had been soaking his feet in his bathtub, while he admits to not cleaning frequently. His tissue culture is growing "Non-lactose fermenting gram negative rods". Microbiology is also able to tell you that it is oxidase positive. What three organisms could this be?
Pseudomonas aeruginosa Aeromonas hydrophilia Burkholderia cepacia
200
What are "oral" antibiotics that are used to treat anaerobes (either above or below the diaphragm)
Metronidazole Amoxicillin/Clavulanate Clindamycin Moxifloxacin (levofloxacin only for oral strep)
300
Your bone marrow transplant patient has been on Vancomycin + Cefepime for neutropenic fever coverage (ANC 0) for approximately 10 days. He unfortunately grows an Acinetobacter that the microbiology lab reports is NDM-1+. What does this mean and what should your therapy change to?
NDM-1 is New-Delhi Metallo-betalactamase. Infers resistance to Carbapenems and all b-lactams. The drug of choice to switch therapy would be Colistin (pending final sensitivities).
300
A patient is admitted from the ED to General surgery with the following lab values: WBC = 22 Hemoglobin = 10.5 CRP = 220 Sodium = 130 Glucose = 300 SCr = 1.4 LRINEC score = 10 The surgery resident asks for empiric antibiotics. What do you initially recommend? Note patient has ADR to vancomycin in his chart (ATN)
Linezolid+ Pip/tazo **Clindamycin not needed since linezolid shuts down protein and toxin production**
300
Which of the following oral medications achieves bone concentrations sufficient to treat osteomyelitis (may be one or more answers)? Doxycycline Cefpodoxime Moxifloxacin Linezolid Amoxicillin/clavulanate
Doxycycline Moxifloxacin Linezolid
300
surgical service with a significant laceration to his hand. He states that he was oyster shucking and cut his hand on the shell. Hours after admission his wound becomes necrotic, the patient is in septic shock and requires amputation of his hand. What organism is the likely culprit of this rapid decline
Vibrio vulnificus Which is the number one cause of shellfish-associated deaths in the U.S. Organisms live in salt water marine environments: seawater and estuaries; wound infections result from exposure of a wound to seawater or brackish water containing the organism. Exposure can result from recreational water activities, oyster shucking, sea urchin harvesting, fish fin punctures or handling seafood
300
Interpret the following syphilis serology: EIA - Positive RPR - Negative TP-PA - Positive
Patient has/had syphilis - it is either a past infection that was treated or it was untreated and has been a long time
400
One of your patients on TPN is growing Candida Krusei from his PICC line. He has received fluconazole for a candida albicans UTI approximately 4 weeks ago. What would you empirically choose for this patient (besides line removal)? A. Fluconazole B. Voriconazole C. Micafungin D. Amphotericin B
C. Micafungin
400
A patient presents with a loculated pleural effusion showing the following cytology and fluid analysis: Pleural pH 7.0 Pleural fluid Protein = 30 Serum Protein = 110 Glucose = 45 Pleural LDH = 250 Serum LDH = 300 Gram stain: small GPCs in chains What condition does the patient have and what would be your empiric recommendation?
Exudative pleural effusion based on light's criteria and an empyema Likely strep species (less likely enterococcus) but may cover with Vancomycin + Ceftriaxone initially
400
Which 6 oral medications achieve sufficient prostatic fluid concentrations to treat prostatitis?
Ciprofloxacin Levofloxacin Sulfa/TMP Azithromycin (if chlamydia suspected!) Fosfomycin Doxycycline - not typically used due to organisms isolated
400
What (and where) are the 3 regional endemic dimorphic mycoses that cause clinically relevant fungal infections?
Histoplasma - Mississippi and Ohio River Valleys Coccioides - Central Valley California, Desert SW and Mexican border Blastomyces - Midwest and Ohio river valleys, following Mississippi river up through Minnesota, east of Appalachian mts and St. Lawrence seaway
400
Which of the following antifungal agents can be used for lower urinary tract infections (could be more than 1 answer)? Fluconazole Posaconazole Micafungin Amphotericin B Voriconazole
Fluconazole and Ampho B. Echinocandins and other azoles are not active in urine
500
What are the 6 gram positive organisms know to have intrinsic VANCOMYCIN resistance?
1. Enterococcus casseliflavus 2. Enterococcus gallinarum 3. Leuconostoc 4. Pediococcus 5. Lactobacillus 6. Erysipelothrix rhusiopathiae
500
A patient presents to the emergency department after getting bitten by a rat while sleeping in the tent city underneath I-90 about 5 days ago. He is admitted to medicine with fever, rigors, and polyarthralgias. Bcx are positive for aerobic gram negative rods growing in chains. Empiric therapy and causative organism is?
Streptobacillus moniliformis (Rat Bite Fever) A b-lactam (such as penicillin or ceftriaxone) should be ordered! Avoid FQs or sulfa/TMP
500
What would be your antimicrobial recommendations (dose/drug) for a patient with Vancomycin and ampicillin resistant Enterococcus faecium prosthetic valve endocarditis? Daptomycin MIC = 3.0
Daptomycin 10-12 mg/kg Q24H plus either: Ampicillin 2g Q4h (renal function adjusted) OR Ceftaroline 600mg Q8H
500
What are the 3 causative, parasitic pathogens associated with eosinophilic meningitis?
Gnathostoma Angiostrongylus Baylisascaris
500
Name 5 of the one-pill once daily regimens for a newly diagnosed patient with HIV (brand AND generic!)
Odefsey - emtricitabine/tenofovir AF/rilpivirine Genvoya - emtricitabine/tenofovir AF/cobicistat/elvitegravir Triumeq - abacavir/lamivudine/dolutegravir Stribild- emtricitabine/tenofovir DF/cobicistat/elvitegravir Complera - emtricitabine/tenofovir DF/rilpivirine
M
e
n
u