Question 1

Q: A 68-year-old woman undergoes elective hip replacement surgery. On postoperative day 3, she develops fever (38.9°C), productive cough, and shortness of breath. Chest X-ray shows a right lower lobe infiltrate. She has been on mechanical ventilation for 48 hours due to perioperative complications. Sputum Gram stain shows gram-negative rods. Apply the appropriate empiric antibiotic regimen.

Piperacillin-tazobactam and vancomycin. ***Piperacillin-tazobactam and vancomycin*** - This patient satisfies the criteria for **Ventilator-Associated Pneumonia (VAP)**, having developed a new pulmonary infiltrate more than **48 hours after endotracheal intubation**. - Empiric therapy must cover multidrug-resistant pathogens including **Pseudomonas aeruginosa** (provided by piperacillin-tazobactam) and **Methicillin-resistant Staphylococcus aureus (MRSA)** (provided by vancomycin). *Ceftriaxone and azithromycin* - This regimen is the standard treatment for **Community-Acquired Pneumonia (CAP)** targeting Streptococcus pneumoniae and atypicals. - It lacks sufficient coverage for **Pseudomonas aeruginosa** and **MRSA**, which are highly prevalent in hospital settings and VAP. *Vancomycin alone* - While vancomycin provides excellent coverage for **Gram-positive** bacteria like **MRSA**, it has no activity against **Gram-negative bacilli**. - Since the sputum Gram stain specifically showed **gram-negative rods**, omitting a beta-lactam or aminoglycoside would lead to treatment failure. *Amoxicillin-clavulanate* - This oral or IV medication is typically used for mild infections or **aspiration pneumonia** occurring in a community setting. - It is not considered broad-spectrum enough for **nosocomial infections** and does not cover **Pseudomonas** or **MRSA**. *Levofloxacin alone* - Fluoroquinolone monotherapy is generally insufficient for empiric VAP treatment in patients with high risk for **multidrug resistance**. - There is a high risk of resistance if used alone, and it does not provide reliable coverage for **MRSA** in a hospital environment.

Question

A 68-year-old woman undergoes elective hip replacement surgery. On postoperative day 3, she develops fever (38.9°C), productive cough, and shortness of breath. Chest X-ray shows a right lower lobe infiltrate. She has been on mechanical ventilation for 48 hours due to perioperative complications. Sputum Gram stain shows gram-negative rods. Apply the appropriate empiric antibiotic regimen.

Accepted Answer

Piperacillin-tazobactam and vancomycin

Answer

Ceftriaxone and azithromycin

Answer

Vancomycin alone

Answer

Amoxicillin-clavulanate

Answer

Levofloxacin alone

Hospital-acquired infections — MCQs

Hospital-acquired infections — MCQs

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