CBIC Antimicrobial Stewardship 2 — Questions and Answers
Question 1: Which metric is most commonly used to measure antimicrobial consumption in a hospital setting?
- Defined Daily Doses (DDD) per 1,000 patient-days (Correct answer)
- Total antibiotic purchase cost per quarter
- Number of antibiotic prescriptions written per month
- Percentage of patients receiving any antibiotic
Correct answer: Defined Daily Doses (DDD) per 1,000 patient-days
DDD per 1,000 patient-days is the standard WHO metric for comparing antimicrobial consumption across institutions and over time.
Question 2: A patient with a penicillin allergy history requires treatment for a serious infection. Which stewardship action is most appropriate?
- Perform penicillin allergy assessment/skin testing to clarify true allergy status (Correct answer)
- Always avoid all beta-lactam antibiotics permanently
- Document the allergy and use vancomycin for all future infections
- Prescribe a fluoroquinolone without further evaluation
Correct answer: Perform penicillin allergy assessment/skin testing to clarify true allergy status
Penicillin allergy assessment reduces unnecessary avoidance of beta-lactams, as over 90% of patients labeled allergic can tolerate them.
Question 3: What is the primary goal of prospective audit and feedback in antimicrobial stewardship programs (ASPs)?
- Review ongoing antibiotic orders and provide real-time recommendations to prescribers (Correct answer)
- Restrict antibiotic formulary access after prescriptions are written
- Generate monthly reports for hospital administration
- Train new pharmacy residents in infectious disease
Correct answer: Review ongoing antibiotic orders and provide real-time recommendations to prescribers
Prospective audit and feedback involves reviewing active antibiotic orders and offering prescriber guidance to optimize therapy in real time.
Question 4: Which organism's emergence is most directly linked to prolonged or inappropriate fluoroquinolone use?
- Clostridioides difficile (Correct answer)
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Carbapenem-resistant Enterobacterales (CRE)
- Vancomycin-resistant Enterococcus (VRE)
Correct answer: Clostridioides difficile
Fluoroquinolone use disrupts gut flora and is a major risk factor for Clostridioides difficile infection.
Question 5: In the context of ASP, what does 'de-escalation' mean?
- Narrowing antibiotic spectrum once culture and sensitivity results are available (Correct answer)
- Stopping all antibiotics as soon as a patient improves clinically
- Switching from IV to oral antibiotics regardless of the agent
- Reducing antibiotic dose to minimize toxicity
Correct answer: Narrowing antibiotic spectrum once culture and sensitivity results are available
De-escalation means switching from broad-spectrum empiric therapy to a narrower agent once the causative pathogen and its sensitivities are known.
Question 6: Which of the following best describes the role of an infection preventionist (IP) in an antimicrobial stewardship program?
- Provide surveillance data on resistance patterns and healthcare-associated infections to guide ASP decisions (Correct answer)
- Write antibiotic prescriptions for nursing home patients
- Perform therapeutic drug monitoring for vancomycin levels
- Manage the hospital formulary independently
Correct answer: Provide surveillance data on resistance patterns and healthcare-associated infections to guide ASP decisions
IPs contribute HAI surveillance data and resistance trend information that informs formulary decisions and empiric therapy guidelines.
Question 7: Which laboratory result should prompt an ASP team to consider discontinuing empiric antibiotics in a hospitalized patient?
- Multiple negative cultures from appropriately collected specimens after 48-72 hours (Correct answer)
- A white blood cell count that remains elevated
- Continued fever on day 2 of therapy
- A CRP level above the normal range
Correct answer: Multiple negative cultures from appropriately collected specimens after 48-72 hours
Negative cultures from appropriate sites after adequate incubation suggest a non-bacterial etiology, supporting antibiotic discontinuation.
CBIC Antimicrobial Stewardship 2
Which metric is most commonly used to measure antimicrobial consumption in a hospital setting?