Carbapenems in Treating Carbapenem-Resistant Acinetobacter Baumannii Infections

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Which combination of antibiotics may be effective against Polymyxins-resistant CRAB?

High-dose Fosfomycin and High-dose Trimethoprim
High-dose Meropenem and High-dose Ampicillin/Sulbactam (correct)
High-dose Rifamycins and High-dose Aminoglycosides
High-dose Minocycline and High-dose Tigecycline

What is the purpose of adding β-Lactamases Inhibitors (BLIs) to β-Lactam Antibiotics?

To enhance the effect of β-Lactam Antibiotics against MDR/EDR GNB infections (correct)
To increase the resistance of Gram-negative Bacteria to β-Lactam Antibiotics
To reduce the effectiveness of β-Lactam Antibiotics
To replace β-Lactam Antibiotics with other types of antibiotics

What is the recommended daily dose of Meropenem to treat severe CRAB infections?

≥8 grams per day
≥2 grams per day
≥6 grams per day (correct)
≥4 grams per day

What is the alternative antibiotic combination to Carbapenems for treating CRAB infections?

Minocycline and Tigecycline (B) Signup and view all the answers

Which of the following antibiotics may be effective against High-dose Extended, Prolonged, or Continuous Infusion Meropenem-resistant Acinetobacter baumannii isolates?

High-dose Imipenem/Cilastatin (D) Signup and view all the answers

What is the goal of using High-dose Extended, Prolonged, or Continuous Infusion Carbapenems in combination with other antibiotics?

To treat severe MDR/EDR GNB infections, including CRAB (A) Signup and view all the answers

What is the recommended dosage of Meropenem in combination therapy for CRAB infections?

≥6 g/day (D) Signup and view all the answers

What is the mortality rate in the Colistin monotherapy group in the first study?

46% (B) Signup and view all the answers

What is the clinical failure rate in the Colistin/Meropenem combination therapy group in the second study?

64% (B) Signup and view all the answers

What is the overall mortality rate in the combination Antibiotics' regimens in the systematic review/meta-analysis study?

28.6%-70% (D) Signup and view all the answers

What is the range of Microbiological eradication rates in the combination Antibiotics' regimens?

32.7%-67.3% (A) Signup and view all the answers

What is the dosage of Sulbactam in High-dose Extended Infusion Ampicillin/Sulbactam combination therapy?

6-9 grams per day (D) Signup and view all the answers

What is the recommended dosage of Meropenem in the Triple-Combination Regimen?

2 grams infused over 3 hours every 8 hours (A) Signup and view all the answers

What is the alternative to High-dose Minocycline in the Triple-Combination Regimen?

High-dose Tigecycline (D) Signup and view all the answers

What is the dosage of Ampicillin/Sulbactam in High-dose Extended Infusion combination therapy?

2-4 grams of Sulbactam infused over 4 hours every 8 hours (D) Signup and view all the answers

What is the potential benefit of the Triple-Combination Regimen in treating CRAB infections?

Potentially eradicating Carbapenem-resistant Acinetobacter baumannii (CRAB) infections (B) Signup and view all the answers

What did studies comparing the efficacy of Colistin monotherapy to that of Colistin in combination with Meropenem find?

The combination of Colistin and Meropenem was ineffective (B) Signup and view all the answers

What is the minimum inhibitory concentration (MIC) of Meropenem and/or Imipenem that distinguishes CRAB isolates?

8 µg/ml (C) Signup and view all the answers

Why does the IDSA discourage the use of Meropenem or Imipenem/Cilastatin in CRAB treatment?

Due to increased β-lactam toxicity without clinical advantage (B) Signup and view all the answers

What is the recommended regimen for CRAB infections according to the ESCMID guidelines?

High-dose Extended Infusion Ampicillin/Sulbactam (B) Signup and view all the answers

What is the recommended additional medication to add to the dual core regimen of High-dose Extended Infusion Ampicillin/Sulbactam for CRAB infections?

Meropenem or Imipenem/Cilastatin (A) Signup and view all the answers

What is the primary mechanism of action of Cefiderocol?

Inhibition of OXA-type Class D β-lactamases (A) Signup and view all the answers

What is the recommended use of Cefiderocol in CRAB infections?

Only for CRAB infections that are resistant to other antibiotics or refractory to standard combinations (A) Signup and view all the answers

According to international surveillance studies, what percentage of CRAB isolates are responsive to Cefiderocol at 4 µg/ml or below?

95% (C) Signup and view all the answers

What is the primary indication for Cefiderocol?

Severe urinary tract infections (UTI) caused by susceptible MDR-GNB (C) Signup and view all the answers

What is the recommended duration of infusion for High-dose Extended Infusion Meropenem in CRAB infections?

3 hours every 8 hours (B) Signup and view all the answers

What is the minimum inhibitory concentration (MIC) of Cefiderocol against baumannii-infected mice thigh and lung models?

4 µg/ml or less (D) Signup and view all the answers

What percentage of CRAB isolates are susceptible to Cefiderocol, according to the CLSI susceptibility criteria?

95% (C) Signup and view all the answers

What is the recommended approach for treating CRAB infections with Cefiderocol, according to the IDSA panel?

Using Cefiderocol in combination with other drugs (A) Signup and view all the answers

What is the mortality rate at the conclusion of the clinical study involving 54 patients with CRAB infections in the Cefiderocol group?

49% (B) Signup and view all the answers

What is the main challenge in determining the susceptibility of CRAB to Cefiderocol?

The inconsistent iron levels in the medium (C) Signup and view all the answers

What is the probability of recurrent CRAB infection in the Cefiderocol group in the observational trial?

17% (B) Signup and view all the answers

What is the recommended approach for treating CRAB infections, according to the ESCMID guidelines?

Restricting the use of Cefiderocol to instances in which all other treatment options have failed (A) Signup and view all the answers

What is the minimum inhibitory concentration (MIC90) of Cefiderocol against Acinetobacter.baumannii bacteria?

1-8 µg/ml (A) Signup and view all the answers

What is the main difference between the Cefiderocol and High-dose Extended-infusion Meropenem treatment regimens in the randomized trial?

No significant difference (C) Signup and view all the answers

What is the purpose of using Cefiderocol in combination with other drugs, according to the IDSA panel?

To increase the likelihood of including at least one efficacious agent in the treatment regimen (C) Signup and view all the answers

What is the primary outcome of the CREDIBLE randomized controlled trial for patients with CRAB infections?

No clinical or microbiological benefits of Cefiderocol over BAT (B) Signup and view all the answers

In the APEKS-NP randomized controlled trial, what was the outcome for patients with pneumonia caused by Acinetobacter baumannii?

Comparable mortality, clinical improvement, and microbiological outcomes between Cefiderocol and High-dose Extended-infusion Meropenem (C) Signup and view all the answers

What is the recommended use of Cefiderocol for CRAB infections?

As a component of combination therapy for CRAB infections (A) Signup and view all the answers

What is the mechanism of action of Rifamycin antibiotics?

Inhibition of bacterial RNA Polymerase (C) Signup and view all the answers

What is the potential therapeutic advantage of using Rifabutin instead of Rifampin?

Uncertain (A) Signup and view all the answers

What is the proposed mechanism of synergy between Rifabutin and Polymyxins?

Polymyxins disrupt bacterial membrane permeability, allowing Rifabutin to penetrate cells (D) Signup and view all the answers

What is the outcome of the three randomized trials examining CRAB patients with Colistin or Rifampin?

Comparable mortality rates between Colistin alone and Colistin plus Rifampin (C) Signup and view all the answers

Why do infectious diseases guidelines’ panels not recommend Rifabutin or other Rifamycins for CRAB therapy?

Due to toxicity and drug interactions associated with Rifamycins (C) Signup and view all the answers

What is the limitation of using Rifamycin antibiotics for CRAB infections?

Toxicity and drug interactions (B) Signup and view all the answers

What is the outcome of the study comparing Colistin monotherapy and Colistin plus Rifampin for CRAB pneumonia?

Non-significant difference in mortality rates between Colistin alone and Colistin plus Rifampin (B) Signup and view all the answers

What is the minimum creatinine clearance required for Colistin monotherapy to achieve 90% PTA for fAUC24h/MIC 25 against Acinetobacter baumannii isolates with MIC of 2 µg/ml?

>50 mL/min (A) Signup and view all the answers

What is significantly associated with acute kidney injury (AKI) in patients receiving Colistin treatment?

Plasma concentration >3.3 µg/ml on the seventh day (A) Signup and view all the answers

What is the effect of combining Colistin with Sulbactam or Fosfomycin on CRAB strains?

Synergistic effect (C) Signup and view all the answers

What is the significance of Monte Carlo simulation principles in optimizing medication regimens?

Identifying appropriate antibiotic regimens for empirical or documented treatment (C) Signup and view all the answers

What is the benefit of reducing the dose of Colistin in patients with high MICs?

Preventing nephrotoxicity (A) Signup and view all the answers

What is the significance of the study on optimizing Colistin monotherapy regimens against CRAB infections?

Optimizing medication regimens using susceptibility data as MIC values (B) Signup and view all the answers

What is the percentage of clinical CRAB isolates found to be Colistin-resistant in a European study?

45.5% (D) Signup and view all the answers

What is the effect of combining Colistin with Fosfomycin on mortality rates?

Reduced mortality rates (D) Signup and view all the answers

What is the significance of the review and meta-analysis of seven controlled trials on Colistin?

Colistin is as effective as Imipenem/Cilastatin, Tobramycin, and Tigecycline (D) Signup and view all the answers

What is the type of infection caused by MDR-AB and XDR-AB strains?

Nosocomial infections (D) Signup and view all the answers

What is the primary concern with using Fosfomycin to treat life-threatening conditions?

There is a lack of evidence for its use in such conditions. (D) Signup and view all the answers

What is the significance of Fosfomycin in treating multidrug-resistant pathogens?

It is effective against a wide range of microorganisms, including Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococcus spp. (D) Signup and view all the answers

Why are synergistic regimens with Fosfomycin important?

To increase the bactericidal efficacy of Fosfomycin and prevent antimicrobial resistance. (B) Signup and view all the answers

What is the significance of the AUCss,24h value of approximately 50 µg*h/ml?

It is the target value for unbound Colistin plasma concentration in patients with creatinine clearance 80 mL/min. (B) Signup and view all the answers

What is the primary concern with using Polymyxins for treating CRAB infections?

They do not meet Pharmacokinetics/Pharmacodynamics objectives. (A) Signup and view all the answers

What is the significance of Acinetobacter baumannii in hospitals?

It is a significant cause of nosocomial infections due to its resistance to multiple antimicrobials, including Carbapenems. (D) Signup and view all the answers

What is the significance of Fosfomycin in the treatment of MDR pathogens?

It is a Phosphonic antibiotic discovered in 1969, employed to treat Multidrug-resistant Enterobacteriaceae. (D) Signup and view all the answers

Why is it essential to develop novel treatments for MDR pathogens?

To enhance antimicrobial action and reduce resistance. (A) Signup and view all the answers

What is the significance of the daily dose of at least 450 mg of Colistin base activity?

It is equivalent to approximately 15 MIU of Colistin Methane-Sulfonate. (C) Signup and view all the answers

What is the significance of Carbapenem-resistant Acinetobacter baumannii (CRAB) infections?

They pose a significant public health threat due to Carbapenem resistance. (A) Signup and view all the answers

What is the primary mechanism of action of Fosfomycin?

Affecting the synthesis of peptidoglycan (A) Signup and view all the answers

Which of the following factors is NOT a risk factor for Acinetobacter MDR colonization?

Age less than 18 years (B) Signup and view all the answers

What is the typical antibiotic resistance profile of ICU isolates of A.baumannii?

Resistant to β-Lactams, Aminoglycosides, and Fluoroquinolones (D) Signup and view all the answers

What is the primary advantage of Fosfomycin in treating infections?

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

What is the recommended treatment approach for CRAB infections?

Combination antimicrobial therapy (B) Signup and view all the answers

What is the mechanism by which Fosfomycin modifies immune responses?

Affecting TNF-, IL-1, and IL-6 levels in lymphocytes, monocytes, and neutrophils (D) Signup and view all the answers

What is the significance of Fosfomycin in treating nosocomial infections?

It is crucial for treating nosocomial infections (C) Signup and view all the answers

What is the typical resistance rate of IV Fosfomycin?

3.4% (D) Signup and view all the answers

What is the significance of colistin in treating CRAB infections?

It is the most favored treatment for CRAB infections (D) Signup and view all the answers

What is the primary goal of primary infection control measures for A.baumannii?

Screening for resistant bacteria and providing chlorhexidine baths for source management (C) Signup and view all the answers