Infectious Diseases 1 – Pharmacy & Acute Care University

*Pertained to the following cased based on the 2019 Community Acquired Pneumonia American Thoracic Society and Infectious Diseases Society of America guidelines

BM is a 28-year-old male presented to emergency department with a chief complaint of chest pain, cough and fever. Patient was not able to finish a complete sentence and appeared to be confused. Past medical history is significant for diabetes mellitus type I that is being treated with insulin glargine 25 units daily and insulin aspart 5 units three times daily with meals. Physical exam included, BP 127/78 mmHg, HR 65 beats per minutes, temperature 99.1°F, and RR 33 breathes/minutes. Chest x-ray revealed multilobar infiltrates.

What is the likely causative pathogen of BM’s symptoms?

A. Acinetobacter baumannii
B. Streptococcus pneumoniae
C. Klebsiella oxytoca
D. Bacillus subtilis

* Pertained to the following cased based on the 2019 Community Acquired Pneumonia American Thoracic Society and Infectious Diseases Society of America guidelines

BM is a 28-year-old male presented to emergency department with a chief complaint of chest pain, cough and fever. Patient was not able to finish a complete sentence and appeared to be confused. Past medical history is significant for diabetes mellitus type I that is being treated with insulin glargine 25 units daily and insulin aspart 5 units three times daily with meals. Physical exam included, BP 127/78 mmHg, HR 65 beats per minutes, temperature 99.1°F, and RR 33 breathes/minutes. Chest x-ray revealed multilobar infiltrates.

Which of the following empiric antibiotic therapy is appropriate for BM?

A. Ceftriaxone 2 g IV once daily plus levofloxacin 750 mg IV once daily
B. Ceftriaxone 2 g IV once daily, levofloxacin 750 mg IV once daily plus vancomycin 15-20 mg/kg IV twice daily (AUC/MIC goal of 400-600)
C. Ceftriaxone 2 g IV once daily plus azithromycin 500 mg IV once daily
D. Ceftriaxone 2 g IV once daily, azithromycin 500 mg IV once daily plus piperacillin-tazobactam 4.5 g IV every 6 hours

* Pertained to the following cased based on the 2019 Community Acquired Pneumonia American Thoracic Society and Infectious Diseases Society of America guidelines

BM is a 28-year-old male presented to emergency department with a chief complaint of chest pain, cough and fever. Patient was not able to finish a complete sentence and appeared to be confused. Past medical history is significant for diabetes mellitus type I that is being treated with insulin glargine 25 units daily and insulin aspart 5 units three times daily with meals. Physical exam included, BP 127/78 mmHg, HR 65 beats per minutes, temperature 99.1°F, and RR 33 breathes/minutes. Chest x-ray revealed multilobar infiltrates.

What is the suggested duration of therapy?

A. 5 days
B. 10 days
C. 14 days
D. 3 days

* Pertained to the following cased based on the 2016 Hospital-acquired and Ventilator-associated Pneumonia Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society

JJ is 35-year-old female with no significant past medical history. Patient was brought to the ED by EMS Ambulance Service following a car accident. Patient was intubated and transferred trauma intensive care unit (ICU). After being on mechanical ventilation for 6 days, patient developed fever (T-max of 100.1°F), became hypotensive and required initiation of vasopressors. Additionally, a chest X-ray showed new infiltrates.

What is the likely causative pathogen of BM’s symptoms?

A. Possibly a gram-negative pathogen such as Pseudomonas aeruginosa or Klebsiella pneumoniae
B. Possibly a gram-negative pathogen such as Neisseria gonorrhoeaeor or Chlamydia trachomatis
C. Possibly a gram-positive pathogen such as Gardnerella vaginalis or Listeria monocytogenes
D. Possibly a gram-positive pathogen such as Clostridium tetani or Lactococcus lactis

* Pertained to the following cased based on the 2016 Hospital-acquired and Ventilator-associated Pneumonia Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society

JJ is 35-year-old female with no significant past medical history. Patient was brought to the ED by EMS Ambulance Service following a car accident. Patient was intubated and transferred trauma intensive care unit (ICU). After being on mechanical ventilation for 6 days, patient developed fever (T-max of 100.1°F), became hypotensive and required initiation of vasopressors. Additionally, a chest X-ray showed new infiltrates.

Which of the following empiric antibiotic therapy is appropriate for JJ?

A. Vancomycin 15-20 mg/kg IV twice daily (AUC/MIC goal of 400-600) plus cefepime 2 g IV every 8 hours
B. Vancomycin 15-20 mg/kg IV twice daily (AUC/MIC goal of 400-600) plus piperacillin-tazobactam 4.5 g IV every 6 hours
C. Vancomycin 15-20 mg/kg IV twice daily (AUC/MIC goal of 400-600), ceftriaxone 2 g IV once daily plus piperacillin-tazobactam 4.5 g IV every 6 hours
D. Vancomycin 15-20 mg/kg IV twice daily (AUC/MIC goal of 400-600), cefepime 2 g IV every 8 hours plus levofloxacin 750 mg IV once daily

* Pertained to the following cased based on the 2016 Hospital-acquired and Ventilator-associated Pneumonia Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society

JJ is 35-year-old female with no significant past medical history. Patient was brought to the ED by EMS Ambulance Service following a car accident. Patient was intubated and transferred trauma intensive care unit (ICU). After being on mechanical ventilation for 6 days, patient developed fever (T-max of 100.1°F), became hypotensive and required initiation of vasopressors. Additionally, a chest X-ray showed new infiltrates.

What is the suggested duration of therapy?

A. 5 days
B. 7 days
C. 10 days
D. 14 days

DA is a 22-year-old female presented to ED complaining of painful urination and vaginally discharge. Patient does not have any past medical history. Patient dined drinking and smoking. Patient is single and lives with her parents. Patient endorsed having recent sexual activities. What is the optimal empiric therapy for DA?

A. Doxycycline 100 mg PO plus ceftriaxone 500 mg IM
B. Doxycycline 100 mg plus cefuroxime 250 mg PO
C. Amoxicillin 500 mg plus cefuroxime 250 mg PO
D. Amoxicillin 500 mg plus ceftriaxone 500 mg IM

LM is a 29-year-old male who does not have a significant past medical history. Patient had an anaphylactic reaction to cephalosporins a few years ago. Patient dined smoking and endorsed social drinking. Patient is single and lives alone. Patient was diagnosed with gonorrhea. Which of the following is an appropriate therapy for LM?

A. Ceftriaxone 500 mg IM
B. Doxycycline 100 mg PO
C. Gentamicin 240 mg IM
D. Cefixime 800 mg PO

DF is a 34-year-old female with a past medical history significant for hypertension and diabetes mellitus type II. At home patient is on metformin 500 mg PO BID and lisinopril 40 mg PO QD, and amlodipine 5 mg PO QD. Patient was recently diagnosed with pelvic inflammatory disease (PID) based on the endometrial biopsy that showed histopathologic evidence of endometritis. The medical team approached you for a pharmacotherapy recommendation, how would you respond?

A. Cefixime 800 mg PO doxycycline 100 mg PO every 12 hours, plus metronidazole 500 mg PO every 12 hours
B. Ceftriaxone 1 g IV once daily, doxycycline 100 mg PO every 12 hours, plus metronidazole 500 mg PO every 12 hours
C. Cefixime 800 mg PO doxycycline 100 mg PO every 12 hours, plus azithromycin 500 mg IV once daily
D. Cefixime 800 mg PO doxycycline 100 mg PO every 12 hours, plus piperacillin-tazobactam 4.5 g IV every 6 hours

* Pertained to the following cased based on the 2021 Clinical Practice Guideline by the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America Guidelines on Management of Clostridioides difficile

DM is a 79-year-old male who lives in a nursing home with a significant past medical history for hypertension, diabetes mellitus type I and depression. Patient is on insulin NPH 12 units BID and insulin aspart 3 units three times daily before meals, amlodipine 5 mg PO QD, and sertraline 50 mg PO QD. Nurse taking care of the patient reported that patient been having four diarrheal episodes a day. Patient was diagnosed with Clostridioides difficile based on PCR and toxins. What is the most appropriate first line therapy for patient’s Clostridioides difficile?

A. Fidaxomicin 200 mg PO twice daily
B. Metronidazole 500 mg PO TID
C. Vancomycin 500 mg 4 times PO

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