| A |
khiladi |
1 |
6% |
| B |
|
0 |
0% |
| C |
cool doctor, inkspot, drdadi, lq2006, solitarius, guangyu, nyimalay, smalley, Markus2009, aspire, Justice |
11 |
69% |
| D |
ansalshah, becky, fd |
3 |
19% |
| Author | 6 Posts |
Justice
Forum Fanatic
Topics: 100
Posts: 1,893
|
Please vote with your answer
A 74-year-old woman is hospitalized because of chills, fever, flank pain and tenderness, dysuria, and urinary urgency and frequency. Urinalysis shows pyuria, and a urine culture grows Escherichia coli that is sensitive to ceftriaxone but is resistant to ceftazidime, fluoroquinolones, and trimethoprim/sulfamethoxazole.
The patient is treated with ceftriaxone for 10 days but remains febrile. Because of persistent fever, she is transferred to another hospital 2 weeks later. Urine culture obtained at the second hospital again grows E. ccli that is sensitive to ceftriaxone, cefepime, imipenem, and piperacillin/tazobactam but is resistant to ceftazidime, fluoroquinolones, and trimethoprim/sulfamethoxazole.
CT scan of the abdomen and pelvis shows no renal or perirenal abscesses, nephrolithiasis, or urinary tract obstruction.
Which of the following is most appropriate regarding this patients antibiotic therapy?
A. Continue ceftriaxone
B. Change to aztreonam
C. Change to imipenem
D. Discontinue all antibiotic therapy
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| inkspot
Forum Guru
Topics: 26
Posts: 554
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treatment failure !
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| guangyu
Forum Elite
Topics: 29
Posts: 308
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C
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| smalley
Forum Elite
Topics: 51
Posts: 284
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c??
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| Markus2009
Forum Senior
Topics: 9
Posts: 189
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C
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| Justice
Forum Fanatic
Topics: 100
Posts: 1,893
|
The correct answer is C
Klebsiella pneumoniae and Escherichia coli strains that are resistant to ceftazidime should be suspected of producing an extended-spectrum β -lactamase (ESBL) that is capable of inactivating all extended-spectrum cephalosporins, penicillins, and aztreonam despite in vitro assay results to the contrary. Infections caused by these organisms may be unresponsive to the antibiotics listed. Hyperproduction of ESBLs may overcome inhibition by β -lactamase inhibitors, such as tazobactam, and may inactivate cefepime, which is usually more resistant to β -lactamases than are other extended-spectrum cephalosporins. The carbapenems are usually active against these organisms. Therefore, the most appropriate therapy for this patient is treatment with a carbapenem such as imipenem.
The other options are inappropriate because many of these strains are resistant to multiple chemically unrelated classes of antimicrobial agents, such as aminoglycosides, tetracyclines, fluoroquinolones, and trimethoprim/sulfamethoxazole.
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