Justice
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A 68-year-old woman is transferred to your institution from an outlying hospital because of worsening pneumonia and respiratory failure. She had been in the other hospital for 11 days following a cerebrovascular accident and a nosocomial urinary tract infection that had been treated with ceftazidime. Her transfer records are incomplete but note that a tracheal aspirate 2 days ago showed copious leukocytes and very resistantAcinetobacter baumannii. A chest radiograph at the time of transfer shows two areas of consolidation in the right lung. These findings are interpreted as being compatible with a hospital-acquired pneumonia. Emergency Gram stain of sputum shows numerous leukocytes and gram-negative coccobacillary forms.
Which of the following is the most reasonable choice of antibiotics for this patient until further information is available?
A. Imipenem
B. Cefepime
C. Levofloxacin
D. Ertapenem
E. Gentamicin
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| peter90036
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sounds pretty bad!
and i forgot all about the treatment of acinetobacter baumannii very resitant to AB...
why is there 2 penems? are they to be eliminated or do they have different spectrum...
its not genta, right? sounds too lame
toughy...
actually i never heard of ertapenem... that must be new
i pick D 
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| ganesha123
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imipenam seems most appropriate for acinetobacter..
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| cool doctor
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I will go for C
Thank you Justice for the Qs and a nice idea to leave the answers for a few days
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| CocaCola
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??? i guess A - imipenem
nosocomial actinobacter pneumonia - tx with cephalosporin or a -penem... ceftazime was used to treat the UTI but it didn't treat the pneumonia - so i would go with imipenem (i never heard of ertapenem)
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| milestogo
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B
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| Markus2009
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A Imipenem(will pick this one)
But it can be ertapenem
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| Justice
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The correct answer is A
Resistant gram-negative bacillary infections are common in very ill hospitalized patients. Many of these infections begin by colonization of patients in intensive care units. Each hospital tends to have certain organisms that predominate, although these change over time. Acinetobacter baumannii is seldom found in ambulatory patients but is one of the most commonly isolated gram-negative organisms in some hospitals. Differentiating between colonization and infection can sometimes be difficult, since infection is almost always preceded by a variable duration of colonization. However, not all patients who are colonized will become infected.
Some Acinetobacter strains are broadly antimicrobial susceptible, but many are multidrug resistant and difficult to treat. Usually the potent carbapenems (for example, imipenem and meropenem) and some of the aminoglycosides (for example, amikacin and tobramycin) are most active in vitro. Some of the β-lactamase inhibitors (especially sulbactam) also demonstrate activity. Cephalosporins such as cefepime and fluoroquinolones such as levofloxacin are usually ineffective. Although there is no substitute for knowing all in vitro data, early use of an active drug is strongly recommended when an infection is highly likely.
The potent carbapenems are usually equally active against Acinetobacter, with the exception of ertapenem. Ertapenem is a once-a-day carbapenem with activity similar to other drugs in that class except that the spectrum does not include Pseudomonas aeruginosa, Acinetobacter species, and some gram-positive bacteria.
The usefulness of aminoglycosides alone or in combination has not been resolved for treating Acinetobacter pneumonia. Resistance to these drugs is variable, although resistance to amikacin is fairly low. Aminoglycosides may not be well suited for treating lung infections despite having good minimal inhibitory concentrations. A combination of drugs may be better for the most critically ill patients, but this issue is unresolved at present.
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