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 Pneumonia in elder Qn: 15  



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Author10 Posts
  #1

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




  #2

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 confused



  #3

imipenam seems most appropriate for acinetobacter..


  #4

I will go for C
Thank you Justice for the Qs and a nice idea to leave the answers for a few days


  #5

??? 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)confused



  #6

B


  #7

A Imipenem(will pick this one)
But it can be ertapenem


  #8

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.


  #9

This is a very good case for 2011.

You get a patient at the end of her life, who was kicked out by another hospital possibly because that hospital cannot take anymore extremely chronically and severely ill patients. The Medicare reimbursement -daddy government- is really tough these days..yeah I know, trillions of debt in 2 shitty wars. The patient comes to you with a disease that would hardly qualify as a community acquired pneumonia...the patient is already f*&^&$ed up with a cerebrovascular disease and a UTI treated for 11 days in another hospital (which is already a blessing, many people from your home country hardly make it to a hospital, many don't see a physician and many don't have potable water)... you rightly diagnose a nosocomial infection. Now, it's time for you to brandish your technical skills at choosing the right antibiotic. Now it's your time to shine. However, by this time you already looked 29 times your Facebook account, made 3 bets in Ebay to purchase discounted tickets to see the NY Yankees which you don't give a damn about, you're already received updates from 7 of your favorite friend's Tweeter accounts telling about their cats' adventures this morning, and because you're so f*[email protected] busy reading so much bullshit you haven't looked at the specific spectra of these big guns antibiotics. And despite all the information is around you... you decide that the right source of information is Kaplan or First Aid....yeah... for whatever reason that might be... so you get a 99 in a shitty test that apparently will define your future. Yeahh, just to get top performance, to handle life & disease in the 99 percentile, at the end of life. You become the very BEST, the most acclaimed physician to save lives at their last fart of their lives. Even if many in your country are starving at the cradle.

By the way, imipenen was the right answer you moron. Next time, find a way to remember it. Jeeezz, this world is full of people with very poor memory!!. Devise some kind of mnemonic or whatever, deal with that, it's up to you. We certainly need the top people. the very best. Ninety niners please come here, I wellcome you!!.


  #10

disapproval imipenem, ertapenem and cefepime all are suitable in these patients but because this patient is in danger of sepsis shock multy drug regimen is mandatory, also piperacillin/tazobactam, meropenem, cefoprazone and levofloxacin are good options but to answer this vague question i think imipenem must be correct so i choose A.





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