CBIC Antimicrobial Stewardship 3 — Questions and Answers
Question 1: Which antibiotic class is associated with the highest risk of selecting for extended-spectrum beta-lactamase (ESBL)-producing organisms?
- Third-generation cephalosporins (Correct answer)
- Carbapenems
- Nitrofurantoin
- Metronidazole
Correct answer: Third-generation cephalosporins
Third-generation cephalosporins exert strong selective pressure for ESBL-producing Enterobacterales, particularly in healthcare settings.
Question 2: An ASP intervention that requires infectious disease approval before dispensing certain restricted antibiotics is called:
- Formulary restriction with prior authorization (Correct answer)
- Prospective audit and feedback
- Antibiotic time-out
- Syndromic management protocol
Correct answer: Formulary restriction with prior authorization
Formulary restriction with prior authorization requires approval from an ID physician or pharmacist before restricted antibiotics can be dispensed.
Question 3: What is the recommended duration of antibiotic therapy for uncomplicated community-acquired pneumonia (CAP) in a hospitalized patient per current IDSA guidelines?
- 5 days if clinical improvement is achieved (Correct answer)
- 10-14 days regardless of clinical response
- 21 days for all hospitalized patients
- Until chest X-ray shows complete resolution
Correct answer: 5 days if clinical improvement is achieved
Current IDSA guidelines support 5-day courses for CAP when the patient achieves clinical stability, reducing unnecessary antibiotic exposure.
Question 4: Which of the following is a key pharmacokinetic/pharmacodynamic (PK/PD) concept important to antimicrobial stewardship?
- Time-dependent killing means beta-lactam efficacy depends on time above the MIC, not peak concentration (Correct answer)
- Concentration-dependent killing means aminoglycoside dosing should be given in divided small doses
- All antibiotics have the same PK/PD target regardless of drug class
- Peak-to-MIC ratio is the relevant target for beta-lactams
Correct answer: Time-dependent killing means beta-lactam efficacy depends on time above the MIC, not peak concentration
Beta-lactams exhibit time-dependent killing; their efficacy is maximized when drug concentration exceeds the MIC for a sufficient percentage of the dosing interval.
Question 5: Which of the following interventions is an example of an IV-to-oral (IV-to-PO) switch program within ASP?
- Transitioning stable patients from IV vancomycin to oral linezolid when oral bioavailability is adequate (Correct answer)
- Continuing IV antibiotics until the entire planned course is completed
- Adding oral probiotics to IV antibiotic therapy
- Converting all IV fluids to oral hydration on day 1
Correct answer: Transitioning stable patients from IV vancomycin to oral linezolid when oral bioavailability is adequate
IV-to-PO switch programs reduce costs, catheter-related complications, and length of stay by transitioning clinically stable patients to oral agents with adequate bioavailability.
Question 6: What is the purpose of an 'antibiotic time-out' in stewardship practice?
- A structured reassessment of antibiotic therapy at 48-72 hours to determine if continuation, modification, or discontinuation is warranted (Correct answer)
- A mandatory 24-hour hold before any antibiotic is prescribed
- A hospital-wide pause in antibiotic administration for infection control audits
- A pharmacist-led review conducted only at patient discharge
Correct answer: A structured reassessment of antibiotic therapy at 48-72 hours to determine if continuation, modification, or discontinuation is warranted
An antibiotic time-out at 48-72 hours allows clinicians to reassess necessity and appropriateness once initial culture and clinical response data are available.
Question 7: Which of the following antibiograms is most useful for guiding empiric antibiotic therapy in a specific patient care unit?
- A unit-specific or location-specific antibiogram showing local resistance patterns (Correct answer)
- A national aggregate antibiogram from all US hospitals
- An antibiogram based solely on outpatient isolates
- A manufacturer-provided antibiogram from clinical trials
Correct answer: A unit-specific or location-specific antibiogram showing local resistance patterns
Unit-specific antibiograms reflect local resistance patterns in a particular care setting (e.g., ICU vs. general ward), making them most actionable for empiric prescribing.
CBIC Antimicrobial Stewardship 3
Which antibiotic class is associated with the highest risk of selecting for extended-spectrum beta-lactamase (ESBL)-producing organisms?