Acinetobacter baumannii Infections and Treatment

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What is the primary concern regarding antibiotic therapy for Acinetobacter baumannii infections?

The ineffectiveness of Polymyxins against CRAB
The uncertainty over whether an isolated organism is colonizing or pathogenic (correct)
The high cost of antibiotic therapy for CRAB infections
The lack of globally recognized antibiotic treatment strategy

What is the effect of Colistin-based combinations on hospitalization-related mortality?

20% reduction in hospitalization-related mortality (correct)
20% increase in hospitalization-related mortality
No significant effect on hospitalization-related mortality
24% reduction in hospitalization-related mortality

What is the limitation of most studies on the effectiveness of antibiotics against CRAB infections?

Unadjusted conclusions (correct)
Lack of control groups
Inadequate follow-up
Small sample size

Why are combinations of antibiotics preferred over Colistin monotherapy for CRAB infections?

Colistin monotherapy is inadequate (B) Signup and view all the answers

What is the current status of finding the most effective treatment for severe CRAB infections?

The most effective treatment is unknown despite its importance (D) Signup and view all the answers

What is a limitation of commercially available medicines like Polymyxins?

They lack consistent In-Vivo CRAB effect (B) Signup and view all the answers

What is the approximate range of the crude mortality rate of Acinetobacter.baumannii in ventilator-associated pneumonia, meningitis, and bacteremia?

25 to 70% (A) Signup and view all the answers

What type of antibiotic resistance is Acinetobacter.baumannii resistant to, leading to a significant medical problem?

All of the above (D) Signup and view all the answers

What is the primary goal of combination treatment in treating Acinetobacter.baumannii infections?

To promote antibiotic synergy (D) Signup and view all the answers

What is the current limitation of using Tigecycline in bloodstream infections?

Low plasma levels (B) Signup and view all the answers

What is the recommended treatment approach for critically ill or high-risk CRAB patients?

Combination therapy with Meropenem, Polymyxin B, and Ampicillin/Sulbactam (A) Signup and view all the answers

Which antibiotic has been linked to resistance development, leading to a recommendation for individualized doses and non-Carbapenem therapies?

Carbapenem (D) Signup and view all the answers

What is the potential benefit of using dual β-Lactam antibiotics, such as Cefiderocol and Meropenem, in treating CRAB?

Synergistic benefits (D) Signup and view all the answers

Which FDA-approved antibiotic is used for treating severe intraabdominal infections (IAIs) with lower MICs against CRAB than Tigecycline?

Eravacycline (A) Signup and view all the answers

What is the target of Eravacycline in treating CRAB infections?

OXA Carbapenemases Class D β-Lactamases enzymes (B) Signup and view all the answers

What is the current limitation of using Eravacycline in treating CRAB infections, based on in-vivo investigations?

It is less effective against CRAB than other anti-CRAB Tetracycline derivatives (D) Signup and view all the answers

In CRAB infection management, what is a crucial factor in reducing mortality?

Eradication of eradicable foci (D) Signup and view all the answers

What is the optimal MIC value for Colistin to ensure effective treatment of CRAB infection?

Less than or equal to 2 µg/ml (D) Signup and view all the answers

What is the effect of using two or more In-Vitro active medications against CRAB?

Reduced mortality compared to single In-Vitro active drug (C) Signup and view all the answers

What is the primary reason for the reduced chances of approval for CRAB infections?

Lack of data from a small, uncontrolled group of patients (D) Signup and view all the answers

What is a key factor influencing severe CRAB infections, including septic shock?

Ineradicable or not-eradicated foci (B) Signup and view all the answers

What is a proposed treatment regimen for severe CRAB infections?

High-dose Extended Infusion Sulbactam/Polymyxins-based regimens with High-dose Tigecycline (B) Signup and view all the answers

Which of the following enzymes is often associated with CRAB isolates?

Carbapenemases Class C and D β-Lactamases (C) Signup and view all the answers

Why do CRAB isolates against Polymyxins have little impact on mortality?

Because Colistin MIC doesn't exceed 2 µg/ml (B) Signup and view all the answers

What is the primary mechanism of Carbapenem resistance in A. baumannii isolates?

Horizontal gene transfer of Carbapenemases from Ambler Classes D or B (A) Signup and view all the answers

What is the role of ISAba1 in Carbapenem resistance?

It is a upstream element that may contribute to Carbapenem resistance (A) Signup and view all the answers

What is the significance of the oxaAb gene in A. baumannii?

It is a marker for speciation (C) Signup and view all the answers

What is the most common clone involved in CRAB outbreaks?

Global Clone 2 (B) Signup and view all the answers

How does CRAB spread?

Through direct and indirect contact with infected individuals and contaminated surfaces and equipment (B) Signup and view all the answers

What is the significance of the oxa23 gene in CRAB isolates?

It is a Carbapenemase gene (C) Signup and view all the answers

What is the consequence of the global spread of CRAB?

Increased economic and clinical issues (C) Signup and view all the answers

What is the significance of the number of studies reporting CRAB?

It indicates a widespread dispersion of CRAB (D) Signup and view all the answers

What is the origin of the baumannii strain in Scotland in 1985?

It originated on the chromosome of Acinetobacter radioresistens (A) Signup and view all the answers

What is the current global rate of Carbapenem resistance?

Around 90% (C) Signup and view all the answers

What is the incidence rate of Carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia in critical care units?

6.3 incidents per 10,000 patient-days (B) Signup and view all the answers

What is the definition of CRAB?

A.baumannii resistance to Imipenem/Cilastatin and Meropenem (C) Signup and view all the answers

What is the result of the multivariate analysis in identifying independent risk factors for mortality?

Ineradicable or non-eradicated focus, septic shock, and inadequate antimicrobial therapy (C) Signup and view all the answers

What is the purpose of identifying risk factors for mortality in severe CRAB infections?

To improve clinical outcomes (D) Signup and view all the answers

What is the definition of appropriate antimicrobial therapy?

Administration of at least one agent with In-Vitro activity against the causative organism (A) Signup and view all the answers

What is the category of anti-CRAB therapies that includes standard-dose or high-dose Ampicillin/Sulbactam?

High/high-dose Ampicillin/Sulbactam (D) Signup and view all the answers

What is the result of the Cox proportional hazards regression analysis?

Ineradicable or non-eradicated focus, septic shock, and inadequate antimicrobial therapy are separate risk factors for death (A) Signup and view all the answers

What is the common characteristic of patients who are at risk of CRAB infection?