Author: Sarah Moore

Stenotrophomonas maltophilia Respiratory Culture has a chronic tracheostomy with a sputum culture growing Stenotrophomonas maltophilia. He is afebrile, has no change in secretions & doesn’t have consolidations on chest X-ray. Does he need treatment? How did others respond? Reveal the answer Best Answer: No, don’t treat Explanation: Stenotrophomonas maltophilia is a nosocomial organism BUT …

Read more “Stenotrophomonas maltophilia Respiratory Culture”

Antibiotic Selection in Pancreatitis presents to the with abdominal pain and infected pancreatic necrosis. Which empiric antibiotic regimen has appropriate coverage AND good pancreatic tissue penetration? How did others respond? Reveal the answer Best Answer: Piperacillin/tazobactam Explanation: Empiric regimens should target enteric gram-negatives and anaerobes. Not all antibiotics have proven efficacy or are known to …

Read more “Antibiotic Selection in Pancreatitis”

PEN-FAST reports a penicillin allergy. You learn he had a non-itching rash in his early 20s but no difficulty breathing or need for treatment. Is it appropriate to challenge his penicillin allergy with oral amoxicillin? How did others respond? Reveal the answer Best Answer: Yes challenge Explanation: This patient is at very low risk …

Read more “PEN-FAST”

Antibiotics in Pancreatitis presents to the with severe abdominal pain & WBCs. A CT scan shows acute pancreatitis without gas, abscess, or necrosis. Do they need antibiotics? How did others respond? Reveal the answer Best Answer No Explanation: Antibiotics are NOT typically indicated in acute pancreatitis. Most cases are due to common noninfectious causes …

Read more “Antibiotics in Pancreatitis”

Altered Mental Status and Bacteriuria presents with confusion . A urinalysis finds bacteria . Does she need antibiotics? Yes No Need more information How did others respond? Reveal the answer Best Answer Need more information Explanation: 2019 IDSA guidelines on asymptomatic bacteriuria (ASB) recommend to OBSERVE elderly patients OFF antibiotics if they do not have …

Read more “Altered Mental Status and Bacteriuria”

Duration of Therapy in Necrotizing Fasciitis presented with necrotizing fasciitis from Streptococcus pyogenes. After 3 debridements, no further surgery is planned. He is afebrile x 48 hours after his last surgery and improving He is on penicillin + clindamycin. What is the BEST antibiotic plan? A. No changeB. Stop clindamycin C. Stop penicillin D. Stop …

Read more “Duration of Therapy in Necrotizing Fasciitis”

Group A Strep Necrotizing Fasciitis presents with necrotizing fasciitis. cultures grow Streptococcus pyogenes (Group A Streptococcus). The team orders penicillin + clindamycin. Your student asks why clindamycin is added since penicillin covers GAS. You tell them… Anti-toxin effect C. difficile risk Penicillin resistance No reason How did others respond? Reveal the answer Best Answer Anti-toxin …

Read more “Group A Strep Necrotizing Fasciitis”

De-Escalation develops hospital-acquired pneumonia & started on empiric vancomycin + cefepime. Sputum cultures grow E. coli with the following susceptibilities: Ceftriaxone = S Cefepime = S Piperacillin/tazobactam = S How did others respond? Reveal the answer Best Answer: Ceftriaxone Explanation: Ceftriaxone will cover the E. coli but does not unnecessarily cover Pseudomonas aeruginosa …

Read more “De-escalation”

Linezolid or Vancomycin for MRSA Pneumonia A was recently in the for influenza.   He is readmitted 2 weeks later with pneumonia. Which EMPIRIC anti-MRSA agent is the best choice?1. Vancomycin2. Linezolid How did others respond? Reveal the answer Best Answer Vancomycin Explanation: Using empiric vancomycin can help preserve linezolid activity against vancomycin-resistant Enterococcus. Positioning …

Read more “Linezolid or Vancomycin for MRSA Pneumonia”

Cefazolin vs Antistaphylococcal Penicillins In which of the following patients would cefazolin be ADVANTAGEOUS over nafcillin for treatment of a MSSA infection? Patient 1 with CNS infection & recent C. difficile Patient 2 with osteomyelitis & hyperkalemia & LFTs How did others respond? Reveal the answer Best Answer Patient 2 Explanation: Cefazolin is favorable …

Read more “Cefazolin vs Antistaphylococcal Penicillins”