Unique or Resistant Pathogens
Microbiology
Bugs!
Drugs!
Diagnostic Stewardship
100
This beta-lactam is the drug of choice for most Lactobacillus spp. implicated in human infections.
What is penicillin (or ampicillin/amoxicillin)?
It is species specific, but most are inherently resistant to vancomycin and cephalosporins.
100
This group of fungi grow as molds when incubated at lower temperatures (< 30C) and as yeasts when incubated at higher temperatures (> 37C).
What are Dimorphic Fungi?
"Mold in the cold, Yeast in the beast"
(eg Histo, Blasto, Cocci, Paracocci, Candida, Sporothrix)
100
The enemy of teenagers. The only thing less cute than acne is a hardware infection from this slow grower!
What is Cutibacterium acnes?
100
This drug is often used in the treatment of HEENT infections in children, but caution should be used as it has poor Streptococcus pneumoniae coverage.
What is cefdinir?
100
In this age group, Group A Strep testing should not be performed routinely.
What is < 3 years old?
200
The class of drugs considered the drug of choice for disseminated or severe ESBL producing Enterobacterales infections.
What are the carbapenems?
Which is most narrow?
200
The hemolysis pattern displayed by Group A (Streptococcus pyogenes) and Group B (Streptococcus agalactiae) strep.
What is beta-hemolysis? (AKA complete hemolysis)
Alpha: incomplete
Gamma: nonhemolytic
200
A 14yo male presents with fever, back pain, & malaise. On exam is ill appearing and noted to have hepatosplenomegaly. His lab values are notable for a WBC of 3 and platelets of 105. On exposure history he reports traveling to Mexico where he tried unpasteurized goats milk. A blood culture is positive and gram stain shows a gram-negative coccobacilli. This is the pathogen likely in his blood.
What is Brucella spp?
(Make sure to warn your friendly lab tech!)
200
This drug is the only beta-lactam with anti-MRSA activity.
What is Ceftaroline?
200
Assuming for an otherwise healthy child or adolescent, these 3 components are needed in the diagnosis of a urinary tract infection.
What are:
1. Pyuria >20
2. Significant growth of a typical uropathogen
3. Signs/symptoms consistent with a urinary tract infection
300
We love Sulbactam as a beta-lactamase inhibitor when paired with Ampicillin, but the perennial side-kick is the hero with direct bactericidal activity against this organism.
What is Acinetobacter?
300
On gram stain, gram-negative organisms stain this color (1) after the addition of this product (BONUS) in Step 4 of gram staining.
What is pink or red?
What is safranin?
1. Applying crystal violet (water soluble dye entering peptidoglycan layer)
2. Adding iodine (forms non-water soluble complex w/ crystal violet)
3. Adding alcohol (decolorizer dehydrates peptidoglycan layer, tightening it, so the thick layer in G+ cells disallows escaping of the iodine/crystal violet complexes. Alcohol being nonpolar, can penetrate G- cells, and outer membrane degrades and more thin peptidoglycan layer unable to retain iodine/crystal violet complexes.)
4. Applying safranin as counterstaining to see the gram-negative organisms
300
Known for its characteristic "sulfur" granules, this organism is commonly associated with dental infections, but can also colonize the skin and GI/GU tracts.
What is Actinomycyes?
300
This drug has long been a hallmark of HIV-therapy and is given as monotherapy for 4 weeks to children born with low-risk exposures to mothers living with HIV.
What is Zidovudine (AZT)?
300
This is the proper volume for blood cultures in children.
What is 1 ml per year of age?
ie 8 yo child = 8 ml total volume, divided into two bottles (aerobic and anaerobic) that each have 4ml
400
Often considered the treatment of choice for Elizabethkingia (gram-negative bacillus) infections even though it is most commonly known for its gram-positive coverage.
What is vancomycin +/- rifampin?
400
A mold preliminarily grows on a sterile site culture. The microbiology labs tells you the hyphae are thin and septated with regular branching at 45 degrees. This is the fungal pathogen likely present.
What is Aspergillus spp?
400
A 17yo female presents with fever, sore throat, hypotension, and a chest xray consistent with embolic disease. An ultrasound of the neck demonstrates a clot in the internal jugular vein. This is the pathogen you are most concerned with.
What is Fusobacterium necrophorum?
(Lemierre's Syndrome)
400
This drug inherently expresses low-level resistance to Enterococcus gallinarum and Enterococcus casseliflavus.
What is vancomycin?
Bonus: Which gene is responsible for this phenotype?
400
This is the likely explanation for a patient without significant diarrhea or ileus with the following C diff testing:
GDH antigen: positive
Toxin: negative
PCR: positive
What is colonization?
As a result, we will routinely NOT be performing reflex to PCR at iOH microbiology lab - will have to call for PCR if GDH(+) and toxin (-).
500
For you gram-negative experts!
The regimen used in the treatment of confirmed metallo-beta-lactamase (MBL) producing Enterobacterales infections.
(2 possible answers)
What is cefiderocol?
What is ceftazidime/avibactam + aztreonam?
500
Mamma Mia! Here we go again with this appetizing KOH prep:
What is Malassezia furfur?
Spaghetti = hyphae; Meatballs = yeast
500
OMG, me and my friends from USC went to this, like, totally grody area of Mexico for spring break and now we feel, like, seriously bad with fever and cough.
What is Coccidioides?
Valley (Girl) Fever
500
The antifungal known for shortening the QT interval, opposite to others in its class of antifungals.
What is isavuconazole?
500
Name 3 rapid diagnostic testing platforms at SLCH?
What is BioFire Pneumonia PCR for lower respiratory samples?
What is the rapid respiratory panel?
What is gram-positive Verigene for blood cultures?
What is rapid p24 HIV antigen?