Clinical Club Quiz- December 2022

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Q1- ST is a 5-year-old female presenting to the emergency department with a 2-day history of fever (Tmax 38.5 °C), otalgia, and ear tugging. Upon evaluation it is determined that she has unilateral acute otitis media with possible effusions and opaque tympanic membrane. Currently, which of the following therapies is most appropriate to initiate for ST?

1 point

A. Amoxicillin 45 mg/kg/dose by mouth twice daily for 7 days

B. Ciprofloxacin 10 mg/kg/dose by mouth twice daily for 7 days

C. Amoxicillin/clavulanate 45 mg/kg/dose by mouth twice daily for 5 days

D. No antibiotic therapy should be initiated at this time.

Clear selection

Q2- A pediatrician is building an outpatient general pediatrics practice and would like to integrate an outpatient antimicrobial stewardship intervention in his clinic. His focus is improving appropriateness of use for patients presenting with signs and symptoms of an acute bacterial rhinosinusitis (ABRS). Which of the following recommendations would be preferred for management of ABRS in this patient population

1 point

A. Reduce use of fluoroquinolones by listing doxycycline as the first-line agent for patients with confirmed ABRS.

B. Recommend clindamycin + third-generation cephalosporin therapy for patients with ABRS and confirmed hypersensitivity to penicillin to reduce fluoroquinolone use.

C. Reduce third-generation cephalosporin use by initiating amoxicillin monotherapy for patients with ABRS

D. Utilize azithromycin + third-generation cephalosporin for treatment of ABRS in penicillin-allergic patients

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Q3- F.P. is a 29-year-old man admitted to the MICU from another hospital with severe, alcohol-induced, sterile acute pancreatitis. During his 5-day stay at the outside hospital, he had multiple organ failure, including respiratory failure requiring tracheostomy. A right internal jugular CVC was placed on the patient’s admission to the outside hospital. On MICU day 3, F.P. has a maximum temperature of 102°F (38.9°C). Two sets of blood cultures are obtained; the right internal jugular catheter is removed and the tip sent for culture.

Which regimen would be best to consider for empiric management of a suspected CLABSI?

0 points

A. Daptomycin and ceftriaxone.

B. Fluconazole.

C. Linezolid and cefepime.

D. Vancomycin, cefepime, and tobramycin.

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Q4- P.H. is a 67-year-old woman admitted from a long-term care facility to the MICU for respiratory failure secondary to severe pneumonia. P.H. is initiated on vancomycin and levofloxacin and has a urethral catheter placed in the emergency department. On ICU day 6, P.H. has a new fever with a temperature of 101.9°F (38.9°C) and an elevated WBC to 18 x 103 cells/mm3, despite an initial clinical response to pneumonia therapy. Blood and urine cultures are sent. Urinalysis reveals many bacteria and greater than 10 white blood cells/mm3.

. Which intervention is most appropriate in P.H.?

1 point

A. Await final culture results before changing the current antibiotic regimen.

B. Continue pneumonia therapy for an extended treatment duration.

C. Initiate empiric antibiotic therapy for a suspected catheter-associated urinary tract infection (CAUTI).

D. Insert a new urinary catheter and resend a urinalysis to confirm CAUTI.

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