GU
AJ is a 29 year-old female with no past medical history admitted to the general medicine service for pyelonephritis. She was treated with cefuroxime as an outpatient but her symptoms progressed so she presented to the ED. Cultures taken as an outpatient are now growing >100,000 cfu Enterococcus faecalis. Susceptibilities are still pending. Based on the UUH antibiogram, what would be an appropriate oral antimicrobial regimen (dosing and duration) for AJ?
Amoxicillin 1000 mg TID x 7 days
CB is a 68-year-old male admitted to the internal medicine service for management of a COPD exacerbation. He reports increased sputum volume, increased sputum purulence and increased shortness of breath in the week leading to his admission. He has not experienced an exacerbation in the last decade and has not experienced any bacterial infection, respiratory or otherwise in the last decade either. You’d like to start antibiotics for CB. What antibiotic would you order?
Azithromycin or Doxycycline
What are the 3 most common causative bacteria for Spontaneous Bacterial Peritonitis?
E coli, K pneumoniae, and S pneumoniae
RW is a 47-year-old female found to have vertebral MRSA osteomyelitis. You are planning on treating her with vancomycin. What is an appropriate duration of antibiotic therapy for osteomyelitis?
6 weeks
Vancomycin is recommended to be administered empirically in combination with ceftriaxone when there is concern for bacterial meningitis. What organism are we covering with vancomycin?
Penicillin-resistant Streptococcus pneumoniae
A patient is being treated for acute bacterial prostatitis. They initially received piperacillin/tazobactam but as they near discharge, you are working to find them an acceptable oral regimen. Of note, they take methadone for opioid use disorder and their last documented QTc is 515 ms. Their eCrCl is 80 mL/min and their potassium is 3.8 mEq/L. What is an appropriate antibiotic choice for this patient?
Trimethoprim/Sulfamethoxazole
IM is a 45-year-old female admitted for CAP. She has a PMH of asthma. She is hemodynamically stable. She reports she had received ampicillin/sulbactam during a previous admission after which she developed anaphylaxis. Her eCrCl is 110 mL/min. What antibiotic regimen could you initially order for treatment of her CAP?
Ceftriaxone or Levofloxacin
SJ is a 42 y/o M presenting with acute on chronic pancreatitis. He reports a 7-day history of poor oral intake and significant pain. He is afebrile, WBC of 15,000 cells/mL, CT imaging shows a peri-pancreatic fluid collection without presence of gas or evidence of necrosis, and he is hemodynamically stable. There are no interventional plans at this time. What is an appropriate empiric antibiotic regimen for SJ?
Trick question! No antibiotics are indicated as SJ does not have evidence of infection
Clindamycin is often added to antimicrobial regimens in patients with suspected necrotizing soft tissue infections for both empiric anaerobic coverage and its ability to decrease toxin production. Which other antibiotic (which covers MRSA) may have toxin inhibiting properties?
Linezolid
What antimicrobial is inactivated by lung surfactant and rhabdomyolysis as a side effect?
Daptomycin
WD is 40-year-old female admitted to the hospital secondary to encephalopathy. In the emergency room, a urinalysis was collected. Her beta-HCG is negative. She denies urinary frequency, urgency, and dysuria. E. coli grows on her urine culture one day after admission. Her mental status is now much improved and her encephalopathy is thought to be secondary to illicit drug use. What antibiotic therapy would you order?
Trick question! We do not treat ASB unless patient is pregnant or about to undergo a urologic procedure
MG is a 78-year-old male admitted to the Surgical ICU after a motor vehicle collision. MG was intubated in the ED thirty days ago. He now has new infiltrates on CXR, a rising white count, and increasing ventilator requirements. A sputum culture is obtained but you now need to start antibiotics. What microbes should your antibiotic selection cover?
S. aureus (including MRSA), P. aeruginosa, and other GNRs
LP is a 70 y/o F admitted following emergent surgical intervention for a large bowel perforation. According to the OR note, the abdomen was grossly contaminated, but complete source control and abdominal closure obtained. LP was started on ceftriaxone 1 gm q24h and metronidazole 500 mg q8h. What is an appropriate duration of antibiotics?
4 days post-source control
KT is a 55-year-old female who underwent a right total knee arthroplasty six months prior to presentation. She undergoes debridement but her prosthesis is retained. Cultures taken in the OR grow MSSA. Ortho requests she receive cefazolin therapy for 6 weeks. What agent may be administered concurrently because of its activity against biofilms present on the prosthesis?
Rifampin
NH has MRSA septic arthritis and is being treated with vancomycin. How will we monitor their vancomycin therapy for both safety and efficacy?
AUC:MIC (both random and trough levels) (Goal AUC:MIC = 400-600)
DJ is a 60 y/o M with paraplegia, neurogenic bladder, and recurrent UTIs. He presents to the ED with back pain, chills, and foul smelling urine. What is the most appropriate empiric regimen for DJ if he recently had a urine culture with Klebsiella Aerogenes (Ceftriaxone R)?
Cefepime
How can you adjust your antibiotic plan with a negative nasal MRSA PCR in a patient with pneumonia who is currently receiving vancomycin and cefepime?
Can discontinue vancomycin
JT is a 72 y/o F with cirrhosis complicated by ascites in which she receives intermittent therapeutic paracenteses (Child-Pugh Score 8, total bilirubin 2.8 mg/dL), type 2 diabetes, and chronic kidney disease (baseline serum creatinine 2.2 mg/dL). JT's most recent paracentesis cytology resulted in PMN count 110 cells/mm3 and total protein of 1.7 g/dL. JT’s reported medication allergies and intolerances include metformin (diarrhea), levofloxacin (arthralgia), and salicylates (rash). What is the best regimen for SBP prophylaxis for JT?
No antibiotics as JT has not had SBP and her ascitic fluid protein does not meet criteria for long term SBP prophylaxis
BONUS: if protein was 1.2 g/dL, what would be the most appropriate antibiotic to start?
TL is a 50 year-old male with T2DM. He presents to the hospital and admitted for management of sepsis. He is noted to have a purulent wound on his left foot. He has not received antimicrobial treatment for this wound. What microbes are the most likely causes of his infection?
Gram positive cocci - specifically S. aureus
What treatment should be given to all pediatric patients admitted for measles?
Vitamin A