CRAB Colonization vs Infection

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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?

To evaluate the presence or absence of CRAB-related colonization and infection (D) Signup and view all the answers

Why are urine catheters commonly used in ICUs?

To facilitate patient care and monitoring (D) Signup and view all the answers

What is a limitation of laboratory testing in most institutions?

It cannot differentiate between infection and colonization (D) Signup and view all the answers

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

Colonization can lead to the spread of resistant bacteria to other patients (B) Signup and view all the answers

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

To initiate targeted actions to prevent transmission to other patients (D) Signup and view all the answers

What is the recommended method for detecting CRAB colonization?

Through a screening test for patients and residents at risk of CRAB colonization (C) Signup and view all the answers

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

To reduce the risk of infection transmission to patients (C) Signup and view all the answers

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

Wear a gown and gloves for patient care (C) Signup and view all the answers

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

Medical equipment can be a source of spread in CRAB outbreaks (B) Signup and view all the answers

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

To reduce the risk of infection transmission to other patients (D) Signup and view all the answers

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

To reduce the risk of infection transmission to patients (C) Signup and view all the answers

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

Following the facility's standardized cleaning and disinfection protocols (D) Signup and view all the answers

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

CRAB can lead to the spread of resistant bacteria to other patients (B) Signup and view all the answers

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

At least daily (A) Signup and view all the answers

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

Using alcohol-based hand sanitizers (A) Signup and view all the answers

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

Using a combination of at least two agents (D) Signup and view all the answers

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

Pneumonia (A) 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?

To optimize treatment efficacy and shorten therapy duration (A) Signup and view all the answers

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

The resistance propensity of the antibiotic in vivo (A) Signup and view all the answers

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

To minimize potential adverse effects (B) Signup and view all the answers

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

Perform additional cultures to identify resistance emergence (A) Signup and view all the answers

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

Appropriate source management (A) Signup and view all the answers

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

Due to lack of evidence and studies demonstrating no benefits (D) Signup and view all the answers

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

Preserving the limited supply of effective antibiotics (D) Signup and view all the answers

What is Colistin used for?

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

What did Vardakas et al. find in their study?

No improvement in survival rates with Colistin-containing combinations (A) Signup and view all the answers

What is the limitation of the IDSA guidelines?

Lack of exhaustive literature review (C) Signup and view all the answers

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

It contains catechol siderophores in its side chains (A) Signup and view all the answers

Why is Eravacycline not currently approved for CRAB infections?

It failed in phase III clinical trials (A) Signup and view all the answers

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

To form a covalent bond with the carbonyl group of the β-Lactam ring (A) Signup and view all the answers

How many naturally occurring β-Lactamases have been catalogued?

Over 2,770 (B) Signup and view all the answers

What is the difference between Serine BLs and Metallo BLs?

Serine BLs contain a reactive serine residue, while Metallo BLs contain one or two Zn2+ ions (B) Signup and view all the answers

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

Hydrolysis of the β-Lactam ring (C) Signup and view all the answers

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

6-12 grams (A) Signup and view all the answers

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

It attains a higher concentration of Sulbactam (A) Signup and view all the answers

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

They are unable to attain Sulbactam concentrations above the MIC (B) Signup and view all the answers

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

It eliminates CRAB and prevents their regrowth (D) Signup and view all the answers

Why are Polymyxins-based combinations limited in their use?

They have limited efficacy range and can induce kidney injury (C) Signup and view all the answers

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

They are superior to Polymyxins-based combinations (C) Signup and view all the answers

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

>30 µg/ml (A) Signup and view all the answers

What is the purpose of using the Extended infusion regimen?

To attain a higher concentration of Sulbactam (C) Signup and view all the answers

Why is Sulbactam an effective treatment for mild CRAB infections?

It saturates modified PBP targets (C) Signup and view all the answers

What is the advantage of combining Fosfomycin with Sulbactam?

It effectively eliminates CRAB and prevents their regrowth (A) Signup and view all the answers

What is the primary function of Metallo-BLs?

To hydrolyze the carbonyl oxygen atom of the β-Lactam ring (D) Signup and view all the answers

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

Amino acid sequence (A) Signup and view all the answers

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

It associates β-Lactamases with clinical significance (C) Signup and view all the answers

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

It facilitates the emergence of new β-Lactamases (D) Signup and view all the answers

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

It is a β-Lactamase inhibitor (C) Signup and view all the answers

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

They are designed to target Class A Serine β-Lactamases (D) Signup and view all the answers

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

It led to the development of Sulbactam and Tazobactam (A) Signup and view all the answers

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

They are designed to target Class A Serine β-Lactamases (D) Signup and view all the answers

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

It reduces mortality rates among critically ill patients with CRAB infections (B) Signup and view all the answers

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

Up to < 6 grams of Sulbactam per day in Ampicillin: Sulbactam ratio of 2: 1 (B) Signup and view all the answers

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

Up to 12 g/day (A) Signup and view all the answers

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

Inhibition of bacterial cell wall formation at two distinct stages of biosynthesis (B) Signup and view all the answers

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

Phosphoenolpyruvate transferase (B) Signup and view all the answers

What is the mechanism of action of Sulbactam?

Inhibition of bacterial cell wall formation (C) 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?

Significant clinical improvement and high cure rates (C) Signup and view all the answers

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

Combination therapy based on Colistin (B) Signup and view all the answers

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

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 (D) Signup and view all the answers

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

May be effective in treating infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii (A) Signup and view all the answers

What is the target of Sulbactam in A. baumannii?

PBP1 and PBP3 (A) Signup and view all the answers

What is the mechanism of synergy between Fosfomycin and Sulbactam?

Inhibition of bacterial cell wall formation at two distinct stages of biosynthesis (A) Signup and view all the answers