Antibiotics For Abscesses A 23-year-old patient receives incision and drainage in the ED for a small abscess on his back and is discharged. Should he have received a prescription for TMP-SMX? How did others respond? Reveal the answer Best Answer Yes Explanation: Incision & drainage (I&D) alone without antibiotics was recommended in the 2014 IDSA …
Higher Cefazolin Urine Breakpoint A 32-year-old patient is sent home from the ED on cephalexin for an uncomplicated UTI. A few days later the urine culture results with a “cefazolin, uncomplicated UTI susceptible” E. coli with an MIC of 8 µg/mL. Does a new prescription need to be called in? How did others respond? Reveal …
Dual β-Lactam Indications A 62-year-old patient is empirically started on ceftriaxone and vancomycin for suspected bacterial meningitis. Later ampicillin is ordered. Should both ampicillin and ceftriaxone be continued, despite both being beta-lactams? How did others respond? Reveal the answer Best Answer Yes Explanation: While sometimes ordered in error, dual β-lactam therapy is appropriate in certain …
Linezolid For Line Infections A patient presents with pain and erythema around a PICC line. The line was removed, blood cultures grew CoNS, and the patient is ready to go home. Is PO linezolid an option? How did others respond? Reveal the answer Best Answer Yes Explanation: Linezolid is a recommended option as definitive therapy …
What To Do When the Vanc MIC is 2? A patient is on D4 of vancomycin for MRSA bacteremia 2nd to a drained skin abscess. Pt is afebrile and wbc wnl. Repeat blood cultures are no growth to date. The MRSA vancomycin MIC is 2 mg/L. Change vanco to dapto? How did others respond? Reveal …
Beat the Bug: Lactobacillus spp A patient started on empiric ceftriaxone and metronidazole is found to have Lactobacillus rhamnosus bacteremia. Should the antibiotics be changed? How did others respond? Reveal the answer Best Answer Yes Explanation: Lactobacillus spp. can cause clinically significant infections, and usual treatment includes penicillin or broader spectrum options, if needed. Penicillin, …
Know Your Antibiotic: Nitrofurantoin A patient is prescribed nitrofurantoin for an uncomplicated UTI in the ED and sent home. Two days later, the urine culture results with P. mirabilis. Should the antibiotic be changed? How did others respond? Reveal the answer Best Answer Yes Explanation: Nitrofurantoin is a preferred option for the management of UTIs …
β-lactam/β-lactamase Inhibitors for MSSA A patient is on empiric piperacillin-tazobactam and found to have MSSA bacteremia. Is de-escalating piperacillin-tazobactam to cefazolin urgent ? How did others respond? Reveal the answer Best Answer Yes Explanation: Beta-lactam/beta-lactamase inhibitors (BLBLIs) such as piperacillin-tazobactam are active against MSSA, but microbiological and observational clinical data suggest worse outcomes compared to …
Amoxicillin-Clavulanate for ESBL UTIs A patient is prescribed cephalexin for a UTI by her primary care doctor. Two days later an ESBL P. mirabilis grows in culture. The only susceptible oral antibiotic is amoxicillin-clavulanate. Should she be admitted for IV antibiotics? How did others respond? Reveal the answer Best Answer Maybe Explanation: The IDSA suggests …
Hemodialysis-only Antibiotic Dosing A patient with a history of chronic HD has been receiving treatment for complicated MSSA bacteremia and is clinically stable for discharge. Ok to complete treatment with thrice weekly cefazolin at the outpatient HD center? How did others respond? Reveal the answer Best Answer Yes Explanation: Cefazolin is primarily renally cleared, therefore …