Antibiogram and MIC Standards Quiz
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Questions and Answers

What is the primary purpose of an antibiogram in a healthcare setting?

  • To display the resistance patterns of pathogens (correct)
  • To list all available antibiotics
  • To show patient outcomes with antibiotics
  • To provide guidelines for antibiotic dosing

    • What does the Minimum Inhibitory Concentration (MIC) indicate in relation to antibiotics?

  • The side effects associated with the antibiotic
  • The effectiveness of an antibiotic against various pathogens (correct)
  • The amount of antibiotic required for patient administration
  • The cost of the antibiotic treatment

    • What organization is primarily responsible for setting the MIC standards for antibiotics?

  • Clinical Laboratory Standards Institute (CLSI) (correct)
  • Centers for Disease Control and Prevention (CDC)
  • European Centre for Disease Prevention and Control (ECDC)
  • World Health Organization (WHO)

    • How long can it take for a facility's lab to incorporate new CLSI recommendations?

    <p>Months to years</p> Signup and view all the answers

    What happens if the MIC value for a pathogen exceeds the maximum susceptible level?

    <p>The pathogen is classified as intermediate or resistant</p> Signup and view all the answers

    What is the significance of understanding the antibiogram at a specific practice setting?

    <p>It helps identify the common patterns of resistance for specific pathogens within that facility.</p> Signup and view all the answers

    How does the Clinical Laboratory Standards Institute (CLSI) influence antibiotic use in clinical settings?

    <p>They set the MIC values, which help determine if pathogens are susceptible or resistant to antibiotics.</p> Signup and view all the answers

    What does it mean if a pathogen shows an Intermediate or Resistant (I/R) classification on a susceptibility report?

    <p>The MIC for that antibiotic is above the established susceptible threshold.</p> Signup and view all the answers

    What factors may contribute to the delay in updating lab processes when new CLSI recommendations are introduced?

    <p>Budget constraints and staffing shortages in the lab.</p> Signup and view all the answers

    What key characteristic differentiates an antibiogram from a national resistance database?

    <p>An antibiogram is generated from recent historical data specific to a healthcare facility.</p> Signup and view all the answers

    Which statement correctly describes the relationship between MIC values and antibiotic susceptibility?

    <p>Exceeding the MIC threshold indicates potential resistance to the antibiotic.</p> Signup and view all the answers

    What is the primary purpose of an antibiogram in a clinical setting?

    <p>To track the efficacy of antibiotics against specific pathogens in the facility.</p> Signup and view all the answers

    Which factor primarily influences the variation of antibiograms across different institutions?

    <p>The geographical location and types of infections prevalent in the area.</p> Signup and view all the answers

    How does the Clinical Laboratory Standards Institute (CLSI) impact antibiotic resistance reporting?

    <p>By providing a framework for determining the MIC for specific pathogens.</p> Signup and view all the answers

    What challenge arises from incorporating new CLSI recommendations into lab processes?

    <p>It often requires significant time for labs to adjust their practices accordingly.</p> Signup and view all the answers

    What is the primary characteristic of antibiograms that makes them unique to each healthcare institution?

    <p>They are created from recent historical data specific to the institution.</p> Signup and view all the answers

    How does the MIC value of 1 for ceftriaxone specifically relate to enterobacterales bacteria like E. coli?

    <p>It classifies susceptibility for values at or below this level.</p> Signup and view all the answers

    What is a key reason for the potential lag in updating facility lab processes to conform to new CLSI recommendations?

    <p>It typically takes months to years for labs to perform necessary changes.</p> Signup and view all the answers

    Which of the following statements accurately reflects what happens when a pathogen is marked as resistant on a susceptibility report?

    <p>It means that the pathogen has a MIC value above the designated threshold for susceptibility.</p> Signup and view all the answers

    What role does the Clinical Laboratory Standards Institute (CLSI) play in relation to antibiotic practices?

    <p>It establishes guidelines for the Minimum Inhibitory Concentrations (MIC) of antibiotics.</p> Signup and view all the answers

    What characterizes each antibiogram in a healthcare facility?

    <p>It is facility-specific and based on recent historical data.</p> Signup and view all the answers

    What primary goal does the Clinical Laboratory Standards Institute (CLSI) serve with regards to antibiotics?

    <p>To set standardized Minimum Inhibitory Concentrations (MIC) for pathogens.</p> Signup and view all the answers

    What is a significant challenge when incorporating new CLSI recommendations into laboratory processes?

    <p>It can require a substantial amount of time for updates.</p> Signup and view all the answers

    Which of the following statements accurately describes the significance of an MIC value above the susceptible threshold?

    <p>The pathogen may be classified as intermediate or resistant.</p> Signup and view all the answers

    What primary factor can lead to considerable variations in antibiograms across different institutions?

    <p>Differences in patient demographics and pathogen exposure.</p> Signup and view all the answers

    What is the primary function of antibiograms in relation to antibiotic use?

    <p>To show pathogen resistance patterns specific to a facility</p> Signup and view all the answers

    Why is it significant for a healthcare facility to learn about its specific antibiogram?

    <p>To tailor antibiotic therapies to the local resistance patterns</p> Signup and view all the answers

    What does it indicate if a pathogen has an MIC value exceeding the maximum susceptible level?

    <p>The pathogen is considered resistant to the antibiotic</p> Signup and view all the answers

    What is a likely consequence of the delays in updating laboratory processes after new CLSI recommendations are released?

    <p>Inaccurate susceptibility reports for local pathogens</p> Signup and view all the answers

    Which of the following best describes the role of the Clinical Laboratory Standards Institute (CLSI) in antibiotic management?

    <p>It sets standards for laboratory processes including MIC values for various pathogens.</p> Signup and view all the answers

    What is a primary reason why antibiograms vary greatly among different institutions?

    <p>Antibiograms are based on recent historical data specific to the facility.</p> Signup and view all the answers

    Which aspect of the MIC is crucial in determining the effectiveness of an antibiotic against a pathogen?

    <p>It marks whether the pathogen is susceptible or resistant to the antibiotic.</p> Signup and view all the answers

    What is a likely implication of a facility taking an extended period to update lab processes with new CLSI recommendations?

    <p>Recommendations may no longer reflect the current resistance patterns.</p> Signup and view all the answers

    In relation to the MIC value for ceftriaxone and enterobacterales, what classification is given when the MIC exceeds 1?

    <p>Intermediate/dose dependent (I)</p> Signup and view all the answers

    What is the role of the Clinical Laboratory Standards Institute (CLSI) in antibiotic management?

    <p>To issue recommendations that labs must adopt for testing and reporting.</p> Signup and view all the answers

    What does a maximum susceptible MIC of 1 for ceftriaxone indicate about enterobacterales like E. coli?

    <p>E. coli can be treated effectively with ceftriaxone within the threshold.</p> Signup and view all the answers

    Which of the following best explains the role of an antibiogram in a clinical practice?

    <p>It indicates how pathogens respond to various antimicrobial agents over time.</p> Signup and view all the answers

    What is a significant factor that can lead to variations in antibiograms across different healthcare institutions?

    <p>Differences in patient demographics and infection types.</p> Signup and view all the answers

    How does local facility-specific antibiograms impact antibiotic prescriptions?

    <p>They allow clinicians to tailor antibiotic therapy based on regional resistance patterns.</p> Signup and view all the answers

    What is the expected outcome if a pathogen is marked as intermediate (I) in a susceptibility report?

    <p>The pathogen can be effectively treated with a higher dose of the antibiotic.</p> Signup and view all the answers

    What is the primary reason that antibiograms vary significantly between healthcare institutions?

    <p>Variations in local pathogen resistance patterns</p> Signup and view all the answers

    What could be a potential consequence of extended delays in updating lab processes to align with new CLSI recommendations?

    <p>Increased risk of administering ineffective antibiotics</p> Signup and view all the answers

    How does the classification of a pathogen as 'intermediate' influence treatment decisions?

    <p>It implies that higher doses of antibiotics may be effective.</p> Signup and view all the answers

    What is a common misconception about the MIC value for ceftriaxone regarding enterobacterales?

    <p>An MIC of 1 indicates a universal susceptibility to ceftriaxone.</p> Signup and view all the answers

    What is one critical function of antibiograms in clinical practice?

    <p>To report current resistance trends to guide antibiotic selection.</p> Signup and view all the answers

    What does a higher MIC value than the maximum susceptible MIC indicate about a pathogen's sensitivity to ceftriaxone?

    <p>The pathogen is more likely to be resistant or intermediate in susceptibility.</p> Signup and view all the answers

    Which factor can significantly affect the interpretation of antibiograms across different healthcare institutions?

    <p>The unique historical resistance patterns observed in each facility.</p> Signup and view all the answers

    How might the prolonged update period of laboratory processes affect patient treatment plans?

    <p>It can result in the potential use of ineffective antibiotics.</p> Signup and view all the answers

    What is a probable consequence if a facility fails to learn its specific antibiogram?

    <p>Higher chances of treating infections with ineffective antibiotics.</p> Signup and view all the answers

    What can be inferred about the timeframe for incorporating new CLSI recommendations in laboratory settings?

    <p>Many labs may struggle to keep pace and face extended delays.</p> Signup and view all the answers

    Which antibiotic is commonly administered via extended infusion due to its pharmacokinetic profile?

    <p>Piperacillin/tazobactam</p> Signup and view all the answers

    What is the likelihood of a patient retaining a penicillin allergy after 10 years of the initial diagnosis?

    <p>80%</p> Signup and view all the answers

    Which of the following factors primarily influences the risk of cross-reactivity between penicillin and other beta-lactams?

    <p>Side chain differences</p> Signup and view all the answers

    What dosing model is primarily used for most antibiotic regimens?

    <p>Intermittent infusion</p> Signup and view all the answers

    In the context of selecting optimal treatments, why is culture collection considered important?

    <p>It allows for targeted therapy based on specific pathogens</p> Signup and view all the answers

    What is essential for accurate urine cultures to avoid compromised treatment?

    <p>Collecting a clean catch specimen</p> Signup and view all the answers

    Which statement best reflects the purpose of antimicrobial stewardship?

    <p>To decrease the risk of multi-drug resistant organisms</p> Signup and view all the answers

    In which scenario would a deep tissue or bone sampling be required?

    <p>For podiatry cultures</p> Signup and view all the answers

    How does rapid molecular testing impact therapeutic decisions?

    <p>It aids in timely guidance for treatment options</p> Signup and view all the answers

    What is the consequence of using an appropriate antimicrobial agent based on a culture report?

    <p>Improved treatment outcomes and reduced resistance</p> Signup and view all the answers

    Which class of antibiotics is known for being time-dependent and bactericidal?

    <p>Beta-lactams</p> Signup and view all the answers

    What defines the 'Right Drug' principle in antimicrobial stewardship?

    <p>Choosing the narrowest effective antimicrobial agent</p> Signup and view all the answers

    Which factor is critical when adjusting dosing regimens for beta-lactam antibiotics?

    <p>Time over the MIC</p> Signup and view all the answers

    What is the primary advantage of using extended infusion for beta-lactams?

    <p>It maintains drug concentration above the MIC for a longer duration.</p> Signup and view all the answers

    Which statement about penicillin allergies is most accurate?

    <p>Approximately 80% of individuals with a confirmed penicillin allergy lose this allergy after ten years.</p> Signup and view all the answers

    Which method is preferred for selecting optimal treatments in antibiotic therapy?

    <p>Targeted therapy based on pure culture results.</p> Signup and view all the answers

    What is a significant factor influencing the cross-reactivity of penicillin with other beta-lactams?

    <p>The structural side chains of the beta-lactams.</p> Signup and view all the answers

    What is the least likely outcome if a patient is treated with cefazolin despite a history of beta-lactam allergy?

    <p>The patient experiences an allergic reaction.</p> Signup and view all the answers

    What is essential for urine cultures to avoid contamination affecting treatment outcomes?

    <p>They must be a clean catch sample.</p> Signup and view all the answers

    In antimicrobial stewardship, which of the following is NOT a principle to guide therapy?

    <p>Optimal Choice</p> Signup and view all the answers

    Which of the following best describes the involvement of institutions regarding antimicrobial stewardship?

    <p>A team approach is generally emphasized among various healthcare providers.</p> Signup and view all the answers

    What considerations can be made for the dosing regimens of beta-lactams?

    <p>Time over MIC is a crucial factor for maximizing treatment efficacy.</p> Signup and view all the answers

    What is a potential drawback of long-acting MRSA agents?

    <p>They are not preferred for treating Clostridioides difficile infections.</p> Signup and view all the answers

    Which of the following describes the impact of culture and susceptibility reports on selecting antimicrobial treatments?

    <p>They assist in identifying the narrowest spectrum antimicrobial agent necessary.</p> Signup and view all the answers

    What is a significant consequence of improper culture collection techniques?

    <p>They can lead to an increase in healthcare costs.</p> Signup and view all the answers

    What limitation does the beta-lactam class primarily have?

    <p>It is only approved for specific types of skin and soft tissue infections (SSTI).</p> Signup and view all the answers

    Which antibiotic administration method is preferred for time-dependent drugs like beta-lactams?

    <p>Extended infusion</p> Signup and view all the answers

    What percentage of patients who have had a confirmed penicillin allergy retain that allergy after ten years?

    <p>80%</p> Signup and view all the answers

    Which of the following antibiotics is noted for having a completely unique side chain that makes it a safer option in patients with a penicillin allergy?

    <p>Cefazolin</p> Signup and view all the answers

    What is the primary goal of applying targeted therapy based on a culture collection?

    <p>To effectively treat infections with optimal specificity</p> Signup and view all the answers

    What is a common misconception regarding the prevalence of penicillin allergies in the general population?

    <p>10% of the population is truly allergic to penicillin</p> Signup and view all the answers

    What is the potential consequence of using a contaminated urine specimen for culture?

    <p>It may lead to an incorrect antibiotic selection.</p> Signup and view all the answers

    Which aspect of antimicrobial stewardship is crucial for reducing the risk of adverse events?

    <p>Using the right drug, dosage, and duration.</p> Signup and view all the answers

    What is a primary reason why long-acting MRSA agents may not be preferred for treating certain conditions?

    <p>They are effective primarily against gram-negative bacteria.</p> Signup and view all the answers

    Which of the following best describes the role of rapid molecular testing in culture practices?

    <p>It provides molecular information to guide therapy before culture results.</p> Signup and view all the answers

    What is a significant challenge faced by healthcare institutions regarding antimicrobial stewardship programs?

    <p>The requirement to report participation to CMS.</p> Signup and view all the answers

    What is a potential drawback of adjusting dosing regimens for beta-lactams to maximize serum levels above the MIC?

    <p>It could result in higher rates of adverse events.</p> Signup and view all the answers

    Which factor contributes to the variation of antibiograms among different institutions?

    <p>Varying patient demographics and local resistance patterns.</p> Signup and view all the answers

    How does antimicrobial stewardship impact the cost to a healthcare institution?

    <p>It tends to reduce costs by minimizing unnecessary treatments.</p> Signup and view all the answers

    Which dosing strategy for IV antibiotics is most commonly used?

    <p>Intermittent infusion</p> Signup and view all the answers

    Which antibiotics are typically preferred for continuous infusion due to their pharmacokinetics?

    <p>Beta-lactams</p> Signup and view all the answers

    What percentage of patients with a reported penicillin allergy will retain it after 10 years?

    <p>Less than 1%</p> Signup and view all the answers

    Which approach is recommended for selecting antibiotics for patients with penicillin allergies?

    <p>Select antibiotics with different side chains.</p> Signup and view all the answers

    Why is culture collection vital in selecting optimal antibiotic treatments?

    <p>It allows for targeted therapy based on a pure culture.</p> Signup and view all the answers

    What is the primary reason for ensuring a clean catch during urine cultures?

    <p>To avoid contamination that may affect treatment.</p> Signup and view all the answers

    What aspect does antimicrobial stewardship primarily aim to address?

    <p>Minimizing adverse events and cost while ensuring effective treatment.</p> Signup and view all the answers

    Which statement accurately describes beta-lactams?

    <p>They are primarily time-dependent and bactericidal antibiotics.</p> Signup and view all the answers

    What challenge is associated with long-acting MRSA agents?

    <p>They are not preferred for treating Clostridioides difficile infections.</p> Signup and view all the answers

    Why is it important for institutions to report antimicrobial stewardship efforts?

    <p>To comply with CMS requirements and accreditation organization standards.</p> Signup and view all the answers

    What defines the 'time over MIC' principle in antibiotic dosing?

    <p>The percentage of a dosing interval where antibiotic levels exceed the MIC.</p> Signup and view all the answers

    Which type of sample is required for podiatry cultures to ensure accurate results?

    <p>Deep tissue or bone sampling through pathology.</p> Signup and view all the answers

    What is a common misconception about the use of beta-lactams?

    <p>They are universally effective against all bacterial species.</p> Signup and view all the answers

    Which dosing strategy is typically preferred for medications that work by maximizing time above the MIC?

    <p>Extended infusion</p> Signup and view all the answers

    What is the likelihood that a patient will retain a confirmed penicillin allergy after 10 years?

    <p>Approximately 80%</p> Signup and view all the answers

    What antibiotic is noted for having a unique side chain that reduces the likelihood of cross-reactivity in patients with penicillin allergies?

    <p>Cefazolin</p> Signup and view all the answers

    Which antibiotic regimen typically utilizes intermittent infusion as a standard approach?

    <p>Vancomycin</p> Signup and view all the answers

    What is the primary factor in choosing antibiotics for targeted therapy based on culture results?

    <p>Type of infection and pathogen sensitivity</p> Signup and view all the answers

    What is the significance of using clean catch techniques for urine cultures?

    <p>It minimizes the risk of specimen contamination.</p> Signup and view all the answers

    Which principle is NOT part of antimicrobial stewardship?

    <p>Right Strength</p> Signup and view all the answers

    What is the primary limitation of beta-lactams in treating infections?

    <p>Limited coverage for MSSA.</p> Signup and view all the answers

    How does antimicrobial stewardship help healthcare institutions economically?

    <p>By minimizing the incidence of antibiotic-resistant infections.</p> Signup and view all the answers

    Why might institutions opt for rapid molecular testing before finalizing cultures?

    <p>To reduce the turnaround time for patient management.</p> Signup and view all the answers

    Which of the following describes a characteristic of long-acting MRSA agents?

    <p>They treat anaerobes and have limited activity against C.difficile.</p> Signup and view all the answers

    What does the 'time over MIC' refer to in antibiotic dosing regimens?

    <p>The percentage of the dosing interval serum levels exceed the MIC.</p> Signup and view all the answers

    What must institutions comply with according to CMS regarding antimicrobial stewardship?

    <p>Reporting their antimicrobial stewardship metrics.</p> Signup and view all the answers

    Which dosing strategy is most commonly used in antibiotic regimens?

    <p>Intermittent infusion</p> Signup and view all the answers

    What is the main reason extended infusion and continuous infusion are preferred for certain medications?

    <p>They optimize time above the MIC.</p> Signup and view all the answers

    What percentage of patients are truly allergic to penicillin with an IgE-mediated reaction?

    <p>Less than 1%</p> Signup and view all the answers

    Which antibiotic is commonly recommended for patients with a history of penicillin allergy due to its unique side chain?

    <p>Cefazolin</p> Signup and view all the answers

    How long do most patients who have had a confirmed penicillin allergy retain this allergy?

    <p>After 10 years</p> Signup and view all the answers

    What is the primary reason for ensuring urine cultures are collected via a clean catch method?

    <p>To avoid contamination that may affect treatment</p> Signup and view all the answers

    What is the fundamental principle of antimicrobial stewardship?

    <p>Administering the right drug, dose, and duration</p> Signup and view all the answers

    Which of the following categories of antibiotics are characterized as time-dependent and bactericidal?

    <p>Penicillins and cephalosporins</p> Signup and view all the answers

    Why is it important for institutions to report on antimicrobial stewardship as required by CMS?

    <p>To maintain hospital accreditation and improve infection control</p> Signup and view all the answers

    What is a significant challenge related to the cost of certain long-acting MRSA agents?

    <p>They can reach thousands of dollars per dose, complicating treatment decisions</p> Signup and view all the answers

    What is the role of rapid molecular testing in the context of culture and susceptibility reports?

    <p>To guide therapy in a timely manner before cultures finalize</p> Signup and view all the answers

    What is the indicated use of beta-lactams in treating infections?

    <p>Predominantly covers Strep species with limited MSSA coverage</p> Signup and view all the answers

    Which organization typically requires hospitals to have an antimicrobial stewardship program?

    <p>Centers for Medicare and Medicaid Services (CMS)</p> Signup and view all the answers

    Which of the following dosing strategies is primarily used for time above the MIC medications?

    <p>Extended infusion</p> Signup and view all the answers

    What is a common misconception about penicillin allergies in the population?

    <p>Most patients retain their penicillin allergy over time</p> Signup and view all the answers

    How should healthcare providers select antibiotics for patients with a known penicillin allergy?

    <p>Choose antibiotics with different side chains than the allergic medication</p> Signup and view all the answers

    What is the primary benefit of targeted therapy based on culture results?

    <p>It maximizes treatment effectiveness against specific pathogens</p> Signup and view all the answers

    What is the role of continuous infusion in antibiotic administration?

    <p>To allow for outpatient therapy administration</p> Signup and view all the answers

    What is the primary reason urine cultures must be a clean catch?

    <p>To prevent contamination that can skew treatment decisions</p> Signup and view all the answers

    Which method of culture collection is considered gold standard for the identification of infections?

    <p>Blood cultures with molecular testing</p> Signup and view all the answers

    What principle is central to antimicrobial stewardship?

    <p>Selecting the right drug, dose, and duration for treatment</p> Signup and view all the answers

    Which class of antibiotics primarily covers Strep species but has limited efficacy against MSSA?

    <p>Beta-lactams</p> Signup and view all the answers

    What is a potential consequence of not participating in antimicrobial stewardship as required by CMS?

    <p>Increased cost of care due to resistant infections</p> Signup and view all the answers

    What is the significance of adjusting the dosage regimen in beta-lactams?

    <p>To maximize the time the serum level exceeds the MIC</p> Signup and view all the answers

    Which statement correctly reflects the challenges of long-acting MRSA agents?

    <p>Their use in therapy is limited due to high costs and specific indications.</p> Signup and view all the answers

    What is a key risk associated with inappropriate antibiotic use in relation to adverse events?

    <p>Increased incidences of Clostridioides difficile infections</p> Signup and view all the answers

    Which infusion method is primarily used for optimizing the pharmacokinetics of time above the MIC medications?

    <p>Extended infusion</p> Signup and view all the answers

    What percentage of patients who are reported to have penicillin allergies actually retain that allergy after a decade?

    <p>20%</p> Signup and view all the answers

    Which of the following correctly describes the implication of cross-reactivity in patients with penicillin allergies?

    <p>Cross-reactivity depends on the side chains of the antibiotics.</p> Signup and view all the answers

    What is a significant benefit of using targeted therapy based on a pure culture for infections?

    <p>It reduces the need for combination therapy.</p> Signup and view all the answers

    In which scenario is continuous infusion of antibiotics particularly recommended?

    <p>For medications needing time above the MIC.</p> Signup and view all the answers

    Which of the following is a primary purpose of antimicrobial stewardship?

    <p>To reduce the incidence of adverse events and multi-drug resistant organisms</p> Signup and view all the answers

    What are the key components of the general principle of antimicrobial stewardship?

    <p>Right Drug, Right Duration, Right Dose</p> Signup and view all the answers

    What is a major challenge associated with long-acting MRSA agents in treatment?

    <p>Their high cost complicates therapy options</p> Signup and view all the answers

    Which laboratory process supports timely therapy decisions in infectious disease care?

    <p>Rapid molecular testing prior to final culture results</p> Signup and view all the answers

    What does 'Time over MIC' represent in dosing regimens for beta-lactams?

    <p>The percentage of time the drug concentration exceeds the MIC</p> Signup and view all the answers

    What is the gold standard in managing infectious diseases based on culture reports?

    <p>Following culture and susceptibility reports for targeted therapy</p> Signup and view all the answers

    Which type of sampling is essential for accurate podiatry cultures?

    <p>Deep tissue and/or bone samples through pathology</p> Signup and view all the answers

    Which of the following best describes the limitation of beta-lactams in treating MSSA infections?

    <p>They provide very limited coverage for MSSA</p> Signup and view all the answers

    More than 10% of the population has a true penicillin allergy with an IgE-mediated reaction.

    <p>False</p> Signup and view all the answers

    What percentage of patients with a confirmed penicillin allergy do not retain it after 10 years?

    <p>80%</p> Signup and view all the answers

    Piperacillin/tazobactam is commonly used in ______ infusion dosing strategy.

    <p>extended</p> Signup and view all the answers

    Match the drug with its corresponding characteristic:

    <p>Cefazolin = Has a completely unique side chain leading to low allergy risk Piperacillin = Used for extended infusion therapies Penicillin = Commonly reported allergy among patients Beta-lactams = Group of antibiotics that may cause cross-reactivity</p> Signup and view all the answers

    What is the primary focus of antimicrobial stewardship?

    <p>Right drug, right dose</p> Signup and view all the answers

    A clean catch urine culture is essential to avoid contamination.

    <p>True</p> Signup and view all the answers

    What type of specimens are preferred for podiatry cultures?

    <p>Deep tissue or bone sampling</p> Signup and view all the answers

    The incidence of adverse events and resistance can be reduced through _______.

    <p>antimicrobial stewardship</p> Signup and view all the answers

    Match the following antibiotics with their characteristics:

    <p>Penicillins = Time dependent and bactericidal Cephalosporins = Broad-spectrum coverage Carbapenems = Used for multi-drug resistant organisms Monobactams = Only effective against Gram-negative bacteria</p> Signup and view all the answers

    Which of the following antibiotics primarily covers Strep species?

    <p>Penicillins</p> Signup and view all the answers

    Beta-lactams have an extensive coverage for MSSA.

    <p>False</p> Signup and view all the answers

    What does the term 'Time over MIC' refer to in relation to antibiotic dosing?

    <p>The percentage of a dosage interval where serum levels exceed the MIC.</p> Signup and view all the answers

    Which dosing strategy is commonly used for beta-lactam antibiotics?

    <p>Intermittent infusion</p> Signup and view all the answers

    Less than 1% of the population has a true IgE-mediated penicillin allergy.

    <p>True</p> Signup and view all the answers

    What is the term used to describe the level of antibiotic that must remain above the MIC for efficacy?

    <p>Time above MIC</p> Signup and view all the answers

    A common antibiotic administered through extended infusion is __________.

    <p>piperacillin/tazobactam</p> Signup and view all the answers

    Match the following antibiotics with their properties:

    <p>Cefazolin = Has a unique side chain and low allergy risk Beta-lactams = Preferred for time above MIC Piperacillin/tazobactam = Commonly given via extended infusion Penicillins = Reported allergy in 10% of the population</p> Signup and view all the answers

    What is the gold standard for appropriate infectious disease care?

    <p>Following the culture and susceptibility report</p> Signup and view all the answers

    Deep tissue sampling and pathology are important for podiatry cultures.

    <p>True</p> Signup and view all the answers

    What is one key principle of antimicrobial stewardship?

    <p>Right Drug, Right Dose, Right Duration</p> Signup and view all the answers

    The % of a dosage interval in which the serum level exceeds the MIC is known as ______.

    <p>Time over MIC</p> Signup and view all the answers

    Which of the following is a type of beta-lactam antibiotic?

    <p>Carbapenems</p> Signup and view all the answers

    Match the following types of infections with their relevant treatment considerations:

    <p>C.difficile = Treat with metronidazole Strep Species = Use beta-lactams MRSA = Consider long-acting agents Anaerobes = Treat with clindamycin</p> Signup and view all the answers

    Antimicrobial stewardship teams are typically made up solely of pharmacists.

    <p>False</p> Signup and view all the answers

    What is a primary challenge in using long-acting MRSA agents?

    <p>They are extremely expensive.</p> Signup and view all the answers

    Which antibiotic regimen is most commonly used for intermittent infusion?

    <p>Beta-lactams</p> Signup and view all the answers

    What is a key reason for utilizing antibiotics with different side chains in patients with a reported penicillin allergy?

    <p>To reduce the risk of cross-reactivity with beta-lactams.</p> Signup and view all the answers

    Extended infusion is preferred for ______ medications, such as beta-lactams.

    <p>time above MIC</p> Signup and view all the answers

    Match the antibiotic with its associated characteristic:

    <p>Cefazolin = Unique side chain and low allergy risk Piperacillin/tazobactam = Commonly used for extended infusion Penicillin = Reported allergy in 10% of population Beta-lactams = Preferred for time above MIC</p> Signup and view all the answers

    What is the purpose of following the culture and susceptibility report in infectious disease care?

    <p>To select the narrowest spectrum antimicrobial agent</p> Signup and view all the answers

    Podiatry cultures only require surface swabs of wounds.

    <p>False</p> Signup and view all the answers

    What are the three principles of antimicrobial stewardship?

    <p>Right Drug, Right Dose, Right Duration</p> Signup and view all the answers

    Urine cultures should be a __________ catch to avoid contamination.

    <p>clean</p> Signup and view all the answers

    Match the antibiotic classes with their characteristics:

    <p>Penicillins = Time-dependent and bactericidal Carbapenems = Broad-spectrum antibiotics effective against many pathogens Cephalosporins = Sometimes used for surgical prophylaxis Monobactams = Effective against aerobic Gram-negative bacteria</p> Signup and view all the answers

    What role does rapid molecular testing play in infectious disease diagnostics?

    <p>It provides molecular information prior to finalizing cultures.</p> Signup and view all the answers

    Antimicrobial stewardship practices look the same in all healthcare facilities.

    <p>False</p> Signup and view all the answers

    Long-acting MRSA agents are used to treat __________ and Clostridioides difficile.

    <p>anaerobes</p> Signup and view all the answers

    Which principle should be prioritized when selecting an antibiotic regimen for diabetic foot infections?

    <p>Narrowest spectrum of activity</p> Signup and view all the answers

    Treatment of diabetic foot infections should always include antibiotics for every pathogen identified.

    <p>False</p> Signup and view all the answers

    What type of infections are most often associated with diabetic foot infections?

    <p>Polymicrobial infections</p> Signup and view all the answers

    Empiric therapy for diabetic foot infections should be based on the clinician’s best guess at the likely ______ and their local antibiotic susceptibilities.

    <p>causative pathogens</p> Signup and view all the answers

    Match the antibiotic class with its respective characteristic:

    <p>Fluoroquinolones = Often reserved for resistant pathogens Topical antimicrobial agents = Target site of infection minimally First-line agents = Well-established for common infections Newer agents = Held in reserve for complicated cases</p> Signup and view all the answers

    What is the recommended approach if a patient has a history of drug allergies when treating diabetic foot infections?

    <p>Consider alternative antibiotics based on susceptibility</p> Signup and view all the answers

    Wound culture results in diabetic foot infections are typically monoclonal in nature.

    <p>False</p> Signup and view all the answers

    What should clinicians consult to help manage difficult cases of diabetic foot infections caused by resistant pathogens?

    <p>An infectious diseases/microbiology expert</p> Signup and view all the answers

    Which of the following pathogens should be targeted for empiric antibiotic therapy in mild diabetic foot infections for patients in temperate climates?

    <p>Aerobic gram-positive pathogens</p> Signup and view all the answers

    Empiric treatment for diabetic foot infections should always aim to cover anaerobic pathogens regardless of the severity of the infection.

    <p>False</p> Signup and view all the answers

    What should clinicians consider if Pseudomonas aeruginosa has been isolated in cultures from a diabetic foot infection?

    <p>Empiric antibiotic therapy should cover Pseudomonas aeruginosa.</p> Signup and view all the answers

    For a patient with a moderate to severe diabetic foot infection residing in a tropical climate, an empiric antibiotic regimen should include coverage for __________ pathogens.

    <p>gram-positive and gram-negative</p> Signup and view all the answers

    Match the antibiotic recommendation to its specific criteria:

    <p>Recommendation 16 = Target aerobic gram-positive pathogens in temperate climates for mild infections Recommendation 17 = Select regimens covering gram-positive and gram-negative pathogens in tropical climates Recommendation 18 = Consider Pseudomonas coverage if previously isolated in moderate infections</p> Signup and view all the answers

    What is a key consideration for definitive therapy in diabetic foot infections after initial empiric treatment?

    <p>Base treatment on clinical response and culture results</p> Signup and view all the answers

    Clinical experiences over decades have shown that aerobic gram-negative bacilli are the most common pathogens in diabetic foot infections.

    <p>False</p> Signup and view all the answers

    The goal of initial empiric antibiotic therapy for diabetic foot infections is to cover likely pathogens without prescribing an unnecessarily __________ regimen.

    <p>broad-spectrum</p> Signup and view all the answers

    What is the recommended duration of antibiotic therapy for minor soft tissue infections that resolve quickly?

    <p>Less than 1 week</p> Signup and view all the answers

    If a patient's infection has not resolved after 4 weeks of appropriate therapy, further diagnostic studies are not necessary.

    <p>False</p> Signup and view all the answers

    What are the potential consequences of prolonged antibiotic therapy?

    <p>Increased risks of adverse events, disruption of host microbiomes, higher costs, and more patient inconvenience.</p> Signup and view all the answers

    Antimicrobial stewardship principles emphasize limiting the duration of antibiotic therapy to the __________ number of days needed for effective treatment.

    <p>minimum</p> Signup and view all the answers

    What should a clinician consider if the treatment for a diabetic foot infection appears to be failing?

    <p>Re-evaluate treatment and cover all likely pathogens</p> Signup and view all the answers

    Match the following questions with their relevance to the management of diabetic foot infections:

    <p>Are all likely pathogens covered by the antibiotic? = Determine treatment effectiveness Is the antibiotic being taken as prescribed? = Assess adherence Could there be an undiagnosed complication? = Consider further diagnostics Was there sufficient perfusion for antibiotic delivery? = Evaluate underlying conditions</p> Signup and view all the answers

    The duration of antibiotic therapy for diabetic foot infections is well-defined with optimal guidelines.

    <p>False</p> Signup and view all the answers

    What is one key consideration for antibiotic selection in polymicrobial infections?

    <p>Coverage of all likely pathogens involved.</p> Signup and view all the answers

    Which of the following serum biomarkers may be ordered as an adjunctive measure for diagnosing foot infection in a person with diabetes?

    <p>C-reactive protein</p> Signup and view all the answers

    The presence of sequestrum indicates healthy bone within diabetic foot osteomyelitis.

    <p>False</p> Signup and view all the answers

    What is one feature characteristic of diabetic foot osteomyelitis observed on plain X-rays?

    <p>Loss of bone cortex</p> Signup and view all the answers

    An appropriate specimen for culture should be collected from almost all clinically infected ulcers to determine the causative __________.

    <p>pathogens</p> Signup and view all the answers

    Match the following features with their corresponding descriptions:

    <p>Sequestrum = Devitalized bone separated from normal bone Involucrum = New bone growth outside previously existing bone Cloaca = Opening through which tissue may discharge Periosteal reaction = Elevation of the periosteum indicative of infection</p> Signup and view all the answers

    Which of the following is NOT a feature characteristic of diabetic foot osteomyelitis on X-rays?

    <p>Acute inflammation</p> Signup and view all the answers

    Collecting wound swabs is generally preferred over obtaining specimens by curettage or biopsy for diagnosing foot infections.

    <p>False</p> Signup and view all the answers

    What is the purpose of ordering an inflammatory serum biomarker in a person with diabetes suspected of having a foot infection?

    <p>To aid in establishing the diagnosis</p> Signup and view all the answers

    Which antibiotic agent is NOT recommended for treating diabetic foot infections?

    <p>Tigecycline</p> Signup and view all the answers

    Oral antibiotics are suggested for severe diabetic foot infections from the start.

    <p>False</p> Signup and view all the answers

    What should be considered when selecting an antibiotic for a diabetic foot infection?

    <p>Causative pathogens, their antibiotic susceptibilities, and clinical severity.</p> Signup and view all the answers

    Antibiotic therapy is required in virtually all patients with a soft tissue _____ infection.

    <p>diabetic foot</p> Signup and view all the answers

    What is the primary reason for administering initial antibiotic therapy by the parenteral route for severe diabetic foot infections?

    <p>To achieve immediate high serum levels.</p> Signup and view all the answers

    Match the type of diabetic foot infection with its recommended treatment strategy:

    <p>Mild Infection = Oral antibiotics Moderate Infection = Oral or IV therapy depending on improvement Severe Infection = Initial parenteral therapy Mixed Infection = Combination antibiotics</p> Signup and view all the answers

    What is a suggested action for patients showing improvement from intravenous therapy for diabetic foot infections?

    <p>Switch to oral therapy.</p> Signup and view all the answers

    Topical antimicrobial agents are recommended for treating mild diabetic foot infections.

    <p>False</p> Signup and view all the answers

    What should be done if evidence of infection has not resolved after 4 weeks of therapy?

    <p>Re-evaluate the patient and consider further diagnostics</p> Signup and view all the answers

    Antibiotic therapy for treating wounds should be extended beyond a few weeks to ensure effective treatment.

    <p>False</p> Signup and view all the answers

    List one reason why prolonged antibiotic therapy is discouraged.

    <p>Increased risks of adverse events.</p> Signup and view all the answers

    Minor soft tissue infections that resolve quickly can be treated with less than _____ week of antibiotic therapy.

    <p>one</p> Signup and view all the answers

    Match the duration of antibiotic therapy with the appropriate infection scenario:

    <p>For minor soft tissue infections = Less than one week For some extensive infections = 2-4 weeks When treatment seems to fail = Re-evaluate and reconsider therapy In cases of limb ischemia = May require longer therapy</p> Signup and view all the answers

    What is a common question to consider when treatment appears to be failing?

    <p>Were all likely pathogens covered by the antibiotic agent?</p> Signup and view all the answers

    All studies of diabetic foot infections (DFIs) provide clear recommendations for optimal duration of therapy.

    <p>False</p> Signup and view all the answers

    Prolonged antibiotic therapy for treating infections is associated with greater disruption of the host _____.

    <p>microbiomes</p> Signup and view all the answers

    Which principle should guide the choice of antibiotic treatment in diabetic foot infections (DFI)?

    <p>Selecting the regimen with the narrowest spectrum</p> Signup and view all the answers

    All identified pathogens in a diabetic foot infection need targeted antibiotic treatment.

    <p>False</p> Signup and view all the answers

    What type of therapy has advantages such as limited adverse effects and lower costs when treating local infections?

    <p>topical antimicrobial therapy</p> Signup and view all the answers

    Empiric therapy should be based on the clinician's best guess at the likely ________ and their local antibiotic susceptibilities.

    <p>causative pathogens</p> Signup and view all the answers

    Match the following antibiotic classes with their characteristics:

    <p>Fluoroquinolones = Often restricted for use First line agents = Well-established antibiotic choices Newer agents = Reserved for resistant pathogens Topical agents = Applied locally to limit systemic issues</p> Signup and view all the answers

    What is a common reason for limiting certain antibiotics in clinical practice?

    <p>Safety concerns or resistance issues</p> Signup and view all the answers

    Consulting with an infectious diseases expert is advisable for cases caused by highly resistant pathogens.

    <p>True</p> Signup and view all the answers

    In the management of DFIs, what factors should clinicians consider when choosing an antibiotic?

    <p>History of drug allergies, recent hospitalization, patient co-morbidities, and local antibiotic susceptibilities.</p> Signup and view all the answers

    Which pathogens are primarily targeted for empiric antibiotic therapy in mild diabetic foot infections in temperate climates?

    <p>Aerobic gram-positive pathogens</p> Signup and view all the answers

    Empiric treatment aimed at Pseudomonas aeruginosa is usually necessary in temperate climates.

    <p>False</p> Signup and view all the answers

    What is the recommended initial approach to antibiotic therapy for most patients with diabetic foot infections?

    <p>Empiric treatment</p> Signup and view all the answers

    In cases of moderate to severe diabetic foot infections in tropical climates, it is suggested to cover gram-positive pathogens and commonly isolated gram-negative pathogens as well as possibly _______ anaerobes.

    <p>obligate</p> Signup and view all the answers

    Match the following recommendations to their characteristics:

    <p>Recommendation 16 = Target aerobic gram-positive pathogens in temperate climates Recommendation 17 = Cover gram-positive and gram-negative pathogens in tropical climates Recommendation 18 = Consider Pseudomonas aeruginosa for moderate to severe infections General Rationale = Initial therapy is mainly empiric to cover likely pathogens</p> Signup and view all the answers

    What is the first empirical regimen to consider for a mild diabetic foot infection without complicating features?

    <p>S-S penicillin</p> Signup and view all the answers

    In which climate should clinicians consider the possibility of isolating Pseudomonas aeruginosa based on previous cultures?

    <p>Tropical climate</p> Signup and view all the answers

    Aerobic gram-negative bacilli are infrequently observed in diabetic foot infections in tropical climates.

    <p>False</p> Signup and view all the answers

    The presence of necrosis in a diabetic foot infection suggests a need for stronger antibiotics.

    <p>True</p> Signup and view all the answers

    What should be reconsidered based on clinical response and culture results after initiating empiric therapy?

    <p>Antibiotic regimen</p> Signup and view all the answers

    List one potential empirical regimen for a diabetic foot infection in a patient with a high risk for MRSA.

    <p>Linezolid</p> Signup and view all the answers

    In the case of recent antibiotic exposure leading to a diabetic foot infection, the potential pathogens include _______ and GNR.

    <p>GPC</p> Signup and view all the answers

    What type of organism is likely involved in a diabetic foot infection with a warm climate and macerated ulcer?

    <p>Pseudomonas</p> Signup and view all the answers

    Match the infection severity with its corresponding empirical regimen:

    <p>Mild = S-S penicillin, 1st gen ceph Moderate = Second/third gen ceph Severe = Group 1 or 2 carbapenem High MRSA Risk = Linezolid, T/S, doxycycline</p> Signup and view all the answers

    Second or third generation cephalosporins are appropriate for treating only mild infections.

    <p>False</p> Signup and view all the answers

    Identify an antibiotic that may be considered for infections at risk of resistant GNR.

    <p>Carbapenems</p> Signup and view all the answers

    Study Notes

    Antibiotic Usage in Practice

    • Objectives include understanding foundational infectious disease practice and determining the purpose of common hospital antibiotics.
    • Antibiograms are facility-specific documents created from recent historical data. They show resistance patterns of pathogens to common antibiotics.
    • Antibiograms are crucial for antibiotic use within a specific institution.
    • The guidelines for antibiotic use may differ among institutions.

    Foundational Key Concepts

    • Antibiograms, considered a "report card", show the resistance patterns of bacteria found within a specific institution's facility or setting.
    • Variations in antibiograms exist among different US institutions.
    • The MIC values are predetermined for each antibiotic and bacterial family category.
    • MIC values are used to determine if a bacteria is susceptible or resistant to a particular antibiotic.

    Antibiogram

    • Antibiograms are facility-specific and use historical data to record resistance patterns in pathogens commonly found in the hospital Setting.
    • The purpose of creating an Antibiogram is to provide a key document for the use of antibiotics within a healthcare facility.
    • Antibiograms show how pathogens react to common antibiotics, allowing for appropriate use and treatment.
    • Antibiograms change based on factors such as recent historical data.

    CLSI

    • CLSI, or the Clinical Laboratory Standards Institute, sets Minimum Inhibitory Concentrations (MIC) for various antibiotics used to treat various pathogens.
    • New CLSI recommendations take a significant amount of time to fully incorporate into a facility's laboratory procedures.
    • CLSI recommendations can take months or years to fully integrate depending on facility resources and technical capabilities.

    MIC

    • MIC is a predetermined value determined for each antibiotic and its corresponding bacterial family.
    • This value helps to identify if the bacteria is susceptible or resistant.
    • MIC values can differ among antibiotics, pathogens, and institutions.
    • The specific MIC of an antibiotic vs. pathogen needs to be consulted as different MICs have varying levels of strength (lesser/greater).

    Lab Cascade

    • Laboratory cascades are strategies used by infectious disease and microbiology specialists to ensure appropriate antibiotic utilization.
    • Cascades allow for limiting the potential release of certain therapeutic antibiotics, or limiting the types of antibiotics in reports (limiting the selection) based on susceptibility and clinical preference.
    • This system improves informed and educated antibiotic use and ensures appropriate selections for treatment.

    Order Sets

    • Order sets are institution-specific guidelines for appropriate treatment protocols.
    • Order sets incorporate data from antibiograms and formulary medication lists to guide treatments.
    • Order sets are often created in collaboration with infectious disease specialists.
    • Examples of order sets include sepsis, pneumonia, and meningitis order sets.

    Different Dosing Models

    • There are several dosing strategies for intravenous (IV) antibiotics.
    • Intermittent infusion is commonly used in most antibiotic regimens.
    • Extended and continuous infusions are preferred for time-above-MIC regimens such as beta-lactams.
    • Extended and continuous infusions may better assist in outpatient administration given better stability.

    Penicillin Allergy

    • Penicillin and beta-lactam allergies are relatively common.
    • Cross-reactivity with other beta-lactams can occur depending on side-chain structures.
    • The likelihood of a penicillin allergy decreases over time. Those who were allergic to penicillins may likely not retain the allergy after 10 years.

    Cross Reactivity Chart

    • Cross-reactivity charts visually show possible cross-reactions among different antibiotics.
    • Red markings on the chart indicate potential cross-reactivity.

    Culture Collection

    • Culture collection is essential for selecting optimal treatments.
    • Targeted treatment based on a pure culture yields the best possible therapy outcome.
    • Urine and Podiatric cultures have specific protocols (such as clean catch) for sample collection to ensure accurate results.

    Culture and Sensitivity

    • Following culture and susceptibility results is the gold standard for appropriate infectious disease care.
    • Practitioners can select the best range/spectrum of antibiotics.
    • Cultures and sensitivities can be quicken through the use of molecular processes.

    Antimicrobial Stewardship

    • The principle of antimicrobial stewardship aims to reduce adverse events, multi-drug resistance, and costs associated with antibiotic use.
    • Stewardship is different among institutions but has to be conducted according to the requirements of the Centers for Medicare & Medicaid Services (CMS).
    • Hospital accreditation organizations require antimicrobial stewardship programs.
    • These programs usually consist of various provider roles, pharmacists, nurses, lab personnel, and infection prevention.

    Antibiotics

    • Penicillins, cephalosporins, monobactams, and carbapenems are important antibiotics.
    • The effect of the treatment is often based on the percentage of time the serum level of bacteria exceeds the MIC value.
    • Treatment selection can be adjusted through varying the dose, infusion time, or frequency of antibiotic administration.

    Penicillin

    • Penicillin primarily targets strep species with extremely limited MRSA coverage.
    • There are formulations in oral, IV (with sodium and potassium), and IM formats.
    • Penicillin requires dosage adjustments based on kidney function (renal function).

    Nafcillin

    • Nafcillin is an anti-staphylococcal penicillin treating gram-positive bacteria (GPC).
    • It treats MSSA and some strep species.
    • It has an available sodium formulation.
    • Nafcillin use is not needed on renal function but monitoring the liver functions is still needed.

    Ampicillin

    • Ampicillin covers GPC (strep, enterococcus) and GPR (listeria).
    • It has limited gram-negative coverage.
    • Ampicillin needs to be dosed for renal function.

    Ampicillin/Sulbactam

    • Ampicillin/sulbactam covers GPC (strep, enterococcus) and offers anaerobic coverage.
    • It has limited gram-negative coverage and is dependent on kidney (renal) function.

    Piperacillin/Tazobactam

    • Piperacillin/tazobactam covers gram-positives and gram-negatives, including pseudomonas and several anaerobes.
    • It needs renal function adjustment.
    • This antibiotic can be dosed through intermittent or extended infusion methods.
    • It treats gram negatives with HAP, VAP, and unknown sepsis.

    Cephalosporins

    • Newer generation cephalosporins may be tested for resistance to Gram-negative bacteria.
    • Cephalosporins have varying coverage against gram-positive and gram-negative bacteria and anaerobes, depending on generatio.

    Cefazolin

    • Cefazolin is a first-generation cephalosporin mainly covering gram-positive organisms (staph and strep).
    • It has limited gram-negative coverage and needs to be dosed based on renal function.

    Cefoxitin

    • Cefoxitin, a second-generation cephalosporin, covers basic gram-positives, gram-negatives and some anaerobes.
    • It can be used in surgical cases with increased anaerobic coverage.
    • Oral versions of this medication are not available.

    Ceftriaxone

    • Ceftriaxone, a third-generation cephalosporin, covers gram-positives and gram-negatives.
    • It has good CSF penetration and should not be dosed according to renal function requirements.

    Ceftazidime

    • Ceftazidime, a third-generation cephalosporin, has limited gram-positive coverage but good gram-negative coverage.
    • It penetrates CSF well and is suitable for patients with renal dysfunction.

    Cefepime

    • Cefepime, a fourth-generation cephalosporin, covers gram-positives and gram-negatives, including PSAR.
    • It has good CSF penetration and needs to be dosed based on renal function.
    • It has a black box warning about dosing to avoid risk of neurologic complications.

    Cefaloroline

    • Cefaloroline is a fifth-generation cephalosporin with good coverage against gram-positives and gram-negatives, including MRSA.
    • It is dosed based on renal function.
    • This antibiotic is often reserved in cases that MRSA treatment fails.

    Carbapenems

    • Carbapenems are broad-spectrum antimicrobials typically given to treat ESBL producing organisms, or other MDRO organisms.
    • Carbapenems cover many different organisms, but individual drugs have different spectrums of activity.
    • They are only available intravenously.

    Ertapenem

    • Ertapenem covers gram-positives, anaerobes, and gram-negatives, but has limited enterococcus coverage.
    • It needs to be dosed based on renal function and has major drug interactions (DDI) with valproic acid.

    Meropenem

    • Meropenem, like Ertapenem, covers a broad range of bacteria, including gram-positive, gram-negative organisms and anaerobes, and also including MDROs such as ESBL and PSAR.
    • Meropenem requires renal function adjustments.
    • Extended infusions can be suitable in some situations.

    Aztreonam

    • Aztreonam is a monobactam covering only gram-negatives, including PSAR.
    • Should be used with caution, if possible, in patients with allergies to penicillins due to use of a similar side chain as ceftaridime.
    • It should be dosed based on renal function and is only available intravenously.

    Beta-lactam + Beta-lactamase inhibitor combos

    • These agents offer a higher level of therapy compared to carbapenems and are often used against carbapenem-resistant pathogens.
    • Available options include meropenem/vaborbactam, imipenem/cilastatin/relebactam, ceftazidime/avibactam, and ceftolozone/tazobactam.

    Fluoroquinolones

    • Fluoroquinolones are bactericidal and concentration-dependent antibiotics.
    • Their use is limited by growing resistance, especially in both gram-positive and gram-negative bacteria.
    • They have a limited anaerobic coverage, and should be used with caution given associated toxicities in some patients.

    Fluoroquinolone Toxicity

    • Fluoroquinolones can cause significant adverse effects such as tendonitis, tendon rupture, and various neuromuscular complications, including peripheral neuropathy, CNS disturbances (like seizures and increased ICP), muscle weakness in those with myasthenia gravis, QT prolongation, hepatotoxicity, aortic aneurysm, aortic dissection, and clostridioides difficile.
    • Fluoroquinolone use is usually limited to patients with true drug allergies or in cases where the infection is resistant to other antibiotics. In other situations, the potential benefits of fluoroquinolone use must be considered in relation to the potential patient-specific toxicities.

    Ciprofloxacin

    • Ciprofloxacin, a non-respiratory fluoroquinolone, covers a range of gram-positives, gram-negatives, and atypicals; it can be used with caution in renal patients.
    • This antibiotic has a poor covering of Streptococcus pneumoniae.
    • Ciprofloxacin needs to be dosed based on renal function; available in IV and Oral (po) forms.
    • The clinical use of ciprofloxicin is most important for UTI, and GI infections.

    Levofloxacin

    • Levofloxacin is a respiratory fluoroquinolone.
    • It has good coverage of gram-positives (including strep pneumo).
    • It needs to be dosed based on renal function and is available in IV and oral (po) form.

    Moxifloxacin

    • Moxifloxacin is a respiratory fluoroquinolone.
    • It has a high incidence of QT prolongation.
    • It is not used in UTI and is available in IV and oral (po) forms.

    Clindamycin

    • Clindamycin covers gram-positives and anaerobes.
    • Resistance rates are increasing.
    • It is time-dependent and bacteriostatic, and should be checked with the local antibiogram.
    • It is notable for use in patients with true beta-lactam allergies or strep organisms that are toxin-producing.

    Doxycycline/Minocycline

    • Doxycycline and minocycline cover gram-positives, gram-negatives, and atypicals; are preferred treatments for tick-borne illnesses
    • They are time-dependent and bacteriostatic.
    • Useful for typical uses such as atypical pneumonia.

    Sulfamethoxazole/Trimethoprim

    • Sulfamethoxazole/Trimethoprim covers gram-positives and gram-negatives, but the coverage of strep is limited.
    • It is usually a combined bactericidal treatment (concentration dependent).
    • Needs to be adjusted based on renal function. IV and oral are available formulations.

    Vancomycin

    • Vancomycin covers Gram-positive organisms but is only useful for IV treatment.
    • Needs to be dosed based on renal function.
    • It can be given intravenously, orally, and rectally.

    Daptomycin

    • Daptomycin covers gram-positive bacteria, especially MRSA and VRE.
    • It needs to be dosed based on renal function and should be reserved for treatment failures of other antibiotics.
    • It is primarily intravenous (IV).

    Linezolid

    • Linezolid covers gram-positive bacteria, including MRSA and VRE.
    • It is time-dependent and bacteriostatic.
    • Adverse effects include thrombocytopenia and neurotoxicity.
    • Linezolid is available in intravenous (IV) and oral (PO) formulations.

    Long-Acting MRSA Agents

    • Long-acting agents, such as dalbavancin and oritavancin, are effective against MRSA but require careful consideration due to cost.

    Metronidazole

    • Metronidazole is used to treat anaerobes and Clostridium difficile.
    • Often used as an adjunctive treatment in the context of other antibiotics.

    Rifampin

    • Rifampin is excellent at targeting gram-positive bacteria and biofilm production.
    • Should NEVER be used alone. Use with caution against other drug interactions.

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    Description

    Test your knowledge about the importance of antibiograms in healthcare settings and understand the significance of Minimum Inhibitory Concentration (MIC) for antibiotics. This quiz also covers the organizations responsible for MIC standards and the implications of exceeding susceptible levels.

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