CRAB Colonization vs Infection
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Questions and Answers

What is the primary site of colonization of Carbapenem-resistant Acinetobacter baumannii (CRAB)?

  • Urine, soft tissue samples, and lungs
  • Digestive tract, respiratory tract, skin, and wounds (correct)
  • Skin, wounds, and sterile surfaces
  • Respiratory tract, skin, and wounds

    • What is the significance of cultivating CRAB in sterile or non-sterile sites?

  • To classify the presence of colonization or infection (correct)
  • To evaluate the effectiveness of preventive medication
  • To diagnose infections in immunocompromised patients
  • To replenish medical resources

    • In which patients is preventive medication useful in reducing the risk of CRAB colonization and infection?

  • Patients with urinary tract infections only
  • Patients with organ transplants only
  • Patients with chronic diseases
  • Patients with weakened immune systems (correct)

    • What is the purpose of using sterile cultures and medical devices in CRAB management?

    <p>To evaluate the presence or absence of CRAB-related colonization and infection</p> Signup and view all the answers

    Why are urine catheters commonly used in ICUs?

    <p>To facilitate patient care and monitoring</p> Signup and view all the answers

    What is a limitation of laboratory testing in most institutions?

    <p>It cannot differentiate between infection and colonization</p> Signup and view all the answers

    What is the primary concern with regards to colonization in patients with CRAB?

    <p>Colonization can lead to the spread of resistant bacteria to other patients</p> Signup and view all the answers

    What is the primary goal of identifying patients colonized with CRAB?

    <p>To initiate targeted actions to prevent transmission to other patients</p> Signup and view all the answers

    What is the recommended method for detecting CRAB colonization?

    <p>Through a screening test for patients and residents at risk of CRAB colonization</p> Signup and view all the answers

    What is the primary reason for performing hand hygiene in healthcare facilities?

    <p>To reduce the risk of infection transmission to patients</p> Signup and view all the answers

    What is the recommended practice when caring for patients with CRAB?

    <p>Wear a gown and gloves for patient care</p> Signup and view all the answers

    What is the primary concern with regards to medical equipment in healthcare facilities?

    <p>Medical equipment can be a source of spread in CRAB outbreaks</p> Signup and view all the answers

    What is the primary reason for dedicating non-critical medical equipment to CRAB patients?

    <p>To reduce the risk of infection transmission to other patients</p> Signup and view all the answers

    What is the primary goal of environmental cleaning and disinfection in healthcare facilities?

    <p>To reduce the risk of infection transmission to patients</p> Signup and view all the answers

    What is the recommended method for cleaning and disinfecting medical equipment?

    <p>Following the facility's standardized cleaning and disinfection protocols</p> Signup and view all the answers

    What is the primary concern with regards to CRAB in healthcare facilities?

    <p>CRAB can lead to the spread of resistant bacteria to other patients</p> Signup and view all the answers

    What is the recommended frequency for cleaning high-touch surfaces?

    <p>At least daily</p> Signup and view all the answers

    What is the preferred method for cleaning hands in most clinical situations?

    <p>Using alcohol-based hand sanitizers</p> Signup and view all the answers

    What is the recommended treatment approach for Carbapenem-resistant Acinetobacter baumannii (CRAB) infections?

    <p>Using a combination of at least two agents</p> Signup and view all the answers

    What is the most common disease associated with Carbapenem-resistant Acinetobacter baumannii (CRAB) infections?

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

    What is the purpose of Therapeutic Drug Monitoring (TDM) in treating Carbapenem-resistant Gram-negative bacteria (CR-GNB) infections?

    <p>To optimize treatment efficacy and shorten therapy duration</p> Signup and view all the answers

    What should be considered when selecting antibiotic therapy for Pan-resistant Gram-negative bacteria (PR-GNB) infections?

    <p>The resistance propensity of the antibiotic in vivo</p> Signup and view all the answers

    Why are individualized dosage and administration methods recommended for treating Carbapenem-resistant Gram-negative bacteria (CR-GNB) infections?

    <p>To minimize potential adverse effects</p> Signup and view all the answers

    What should be done after unsuccessful treatment of Carbapenem-resistant Gram-negative bacteria (CR-GNB) infections?

    <p>Perform additional cultures to identify resistance emergence</p> Signup and view all the answers

    What is the primary emphasis in managing infections caused by Carbapenem-resistant Gram-negative bacteria (CR-GNB)?

    <p>Appropriate source management</p> Signup and view all the answers

    Why is the use of Fosfomycin or Rifamycins in combination therapy for refractory/recurrent CRAB infections not recommended?

    <p>Due to lack of evidence and studies demonstrating no benefits</p> Signup and view all the answers

    What is the primary concern in antibiotic stewardship for CR-GNB infections?

    <p>Preserving the limited supply of effective antibiotics</p> Signup and view all the answers

    What is Colistin used for?

    <p>All of the above</p> Signup and view all the answers

    What did Vardakas et al. find in their study?

    <p>No improvement in survival rates with Colistin-containing combinations</p> Signup and view all the answers

    What is the limitation of the IDSA guidelines?

    <p>Lack of exhaustive literature review</p> Signup and view all the answers

    What is unique about the newly developed Siderophore Cephalosporin antibiotic Cefiderocol?

    <p>It contains catechol siderophores in its side chains</p> Signup and view all the answers

    Why is Eravacycline not currently approved for CRAB infections?

    <p>It failed in phase III clinical trials</p> Signup and view all the answers

    What is the function of β-Lactamases (BLs)?

    <p>To form a covalent bond with the carbonyl group of the β-Lactam ring</p> Signup and view all the answers

    How many naturally occurring β-Lactamases have been catalogued?

    <p>Over 2,770</p> Signup and view all the answers

    What is the difference between Serine BLs and Metallo BLs?

    <p>Serine BLs contain a reactive serine residue, while Metallo BLs contain one or two Zn2+ ions</p> Signup and view all the answers

    What is the primary mechanism of β-Lactam antibiotic resistance?

    <p>Hydrolysis of the β-Lactam ring</p> Signup and view all the answers

    What is the recommended dose of Sulbactam per day for treating mild CRAB infections?

    <p>6-12 grams</p> Signup and view all the answers

    What is the advantage of the Extended infusion regimen over the Prolonged or Continuous infusion regimens?

    <p>It attains a higher concentration of Sulbactam</p> Signup and view all the answers

    Why are Prolonged or Continuous infusion regimens less effective against EDR-CRAB isolates?

    <p>They are unable to attain Sulbactam concentrations above the MIC</p> Signup and view all the answers

    What is the benefit of combining Fosfomycin with the Extended Sulbactam infusion?

    <p>It eliminates CRAB and prevents their regrowth</p> Signup and view all the answers

    Why are Polymyxins-based combinations limited in their use?

    <p>They have limited efficacy range and can induce kidney injury</p> Signup and view all the answers

    What is the advantage of High/Higher-dose Sulbactam-based combinations?

    <p>They are superior to Polymyxins-based combinations</p> Signup and view all the answers

    What is the minimum inhibitory concentration (MIC) of Sulbactam in EDR-CRAB isolates?

    <p>&gt;30 µg/ml</p> Signup and view all the answers

    What is the purpose of using the Extended infusion regimen?

    <p>To attain a higher concentration of Sulbactam</p> Signup and view all the answers

    Why is Sulbactam an effective treatment for mild CRAB infections?

    <p>It saturates modified PBP targets</p> Signup and view all the answers

    What is the advantage of combining Fosfomycin with Sulbactam?

    <p>It effectively eliminates CRAB and prevents their regrowth</p> Signup and view all the answers

    What is the primary function of Metallo-BLs?

    <p>To hydrolyze the carbonyl oxygen atom of the β-Lactam ring</p> Signup and view all the answers

    What is the basis of the Ambler Classification scheme for β-Lactamases?

    <p>Amino acid sequence</p> Signup and view all the answers

    What is the significance of the Bush-Jacoby-Medeiros Classification scheme?

    <p>It associates β-Lactamases with clinical significance</p> Signup and view all the answers

    What is the effect of environmental pressure from β-Lactam antibiotics on the emergence of new β-Lactamases?

    <p>It facilitates the emergence of new β-Lactamases</p> Signup and view all the answers

    What is the significance of Clavulanic acid in the development of β-Lactamase inhibitors?

    <p>It is a β-Lactamase inhibitor</p> Signup and view all the answers

    Why are Clavulanic acid and Sulbactam not effective against K. pneumoniae Carbapenemases (KPCs) and other Serine-based Carbapenemases?

    <p>They are designed to target Class A Serine β-Lactamases</p> Signup and view all the answers

    What is the significance of the discovery of Clavulanic acid in the development of β-Lactamase inhibitors?

    <p>It led to the development of Sulbactam and Tazobactam</p> Signup and view all the answers

    Why are the 1st generation β-Lactamase inhibitors not effective against all types of β-Lactamases?

    <p>They are designed to target Class A Serine β-Lactamases</p> Signup and view all the answers

    What is the significance of the administration of Ampicillin/Sulbactam in combination with another non-β-Lactam antibiotic?

    <p>It reduces mortality rates among critically ill patients with CRAB infections</p> Signup and view all the answers

    What is the recommended dose of Sulbactam in Ampicillin/Sulbactam therapy for CRAB infections?

    <p>Up to &lt; 6 grams of Sulbactam per day in Ampicillin: Sulbactam ratio of 2: 1</p> Signup and view all the answers

    What is the daily dose of Sulbactam that can be administered without safety concerns in a clinical setting?

    <p>Up to 12 g/day</p> Signup and view all the answers

    What is the mechanism behind the synergy between Fosfomycin/Sulbactam in the context of Acinetobacter.baumannii?

    <p>Inhibition of bacterial cell wall formation at two distinct stages of biosynthesis</p> Signup and view all the answers

    What is the target of Fosfomycin in the context of Acinetobacter.baumannii?

    <p>Phosphoenolpyruvate transferase</p> Signup and view all the answers

    What is the mechanism of action of Sulbactam?

    <p>Inhibition of bacterial cell wall formation</p> Signup and view all the answers

    What is the efficacy of high-dose Sulbactam or Colistin in combination with other antibacterial agents for the treatment of infections caused by MDR-AB or XDR-AB?

    <p>Significant clinical improvement and high cure rates</p> Signup and view all the answers

    What is the most prevalent treatment for MDR-AB or XDR-AB?

    <p>Combination therapy based on Colistin</p> Signup and view all the answers

    What is the IDSA guidance on the treatment of antimicrobial-resistant Gram-negative infections?

    <p>Sulbactam is a potent β-Lactam β-lactamase Inhibitor (BLBLI) that, when administered in high concentrations, competes with and permanently disables PBP1 and PBP3 in A. baumannii isolates</p> Signup and view all the answers

    What is the effect of high concentrations of Sulbactam and Colistin on MDR-AB or XDR-AB infections?

    <p>May be effective in treating infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii</p> Signup and view all the answers

    What is the target of Sulbactam in A. baumannii?

    <p>PBP1 and PBP3</p> Signup and view all the answers

    What is the mechanism of synergy between Fosfomycin and Sulbactam?

    <p>Inhibition of bacterial cell wall formation at two distinct stages of biosynthesis</p> Signup and view all the answers

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