CBIC Antimicrobial Stewardship 4 — Questions and Answers
Question 1: A patient is diagnosed with asymptomatic bacteriuria. Which ASP recommendation is appropriate for most patients?
- No antibiotic treatment is warranted unless the patient is pregnant or undergoing urologic procedures (Correct answer)
- Treat with a 3-day course of trimethoprim-sulfamethoxazole regardless of symptoms
- Order a repeat urine culture in 48 hours before deciding
- Administer IV antibiotics to prevent urosepsis
Correct answer: No antibiotic treatment is warranted unless the patient is pregnant or undergoing urologic procedures
Treating asymptomatic bacteriuria in non-pregnant, non-surgical patients provides no clinical benefit and increases resistance and adverse effects.
Question 2: Which of the following best describes the concept of 'antibiotic stewardship' as defined by the CDC?
- The coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting selection of the optimal regimen (Correct answer)
- Restricting all antibiotic use to infection control nurses only
- A program focused exclusively on reducing hospital drug costs
- Mandatory infectious disease consultation for all antibiotic orders
Correct answer: The coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting selection of the optimal regimen
The CDC defines antibiotic stewardship as coordinated efforts to optimize antibiotic use, including the right drug, dose, route, and duration for each patient.
Question 3: Which biomarker is most useful for guiding antibiotic discontinuation in patients with suspected sepsis?
- Procalcitonin (PCT) (Correct answer)
- C-reactive protein (CRP)
- Erythrocyte sedimentation rate (ESR)
- Interleukin-6 (IL-6)
Correct answer: Procalcitonin (PCT)
Procalcitonin rises rapidly in bacterial infections and falls quickly with effective treatment, making serial PCT measurements useful for guiding antibiotic de-escalation and stopping decisions.
Question 4: Which of the following infections typically requires the shortest antibiotic course according to current evidence-based guidelines?
- Uncomplicated lower urinary tract infection in women (3 days) (Correct answer)
- Community-acquired pneumonia requiring ICU admission (5 days)
- Staphylococcus aureus bacteremia (14 days minimum)
- Bacterial endocarditis (4-6 weeks)
Correct answer: Uncomplicated lower urinary tract infection in women (3 days)
Uncomplicated cystitis in women is effectively treated with 3-day courses of trimethoprim-sulfamethoxazole or 5-day nitrofurantoin, one of the shortest validated antibiotic durations.
Question 5: In long-term care facilities (LTCFs), which of the following represents a common stewardship challenge?
- High rates of antibiotic prescribing for asymptomatic bacteriuria based on urine dipstick results alone (Correct answer)
- Lack of any antibiotic access in the facility formulary
- Over-reliance on carbapenem therapy for all infections
- Mandatory ID consultation for every antibiotic order
Correct answer: High rates of antibiotic prescribing for asymptomatic bacteriuria based on urine dipstick results alone
LTCFs commonly over-treat asymptomatic bacteriuria detected incidentally on dipstick, contributing significantly to antibiotic overuse and resistance in this population.
Question 6: What is 'cascade reporting' in the context of microbiology and ASP?
- Reporting susceptibility to broader-spectrum antibiotics only when the organism is resistant to narrower agents, to promote use of narrower therapy (Correct answer)
- Releasing all susceptibility results simultaneously to the clinician
- A process of reporting culture results in alphabetical order
- Withholding culture results until the clinical team requests them
Correct answer: Reporting susceptibility to broader-spectrum antibiotics only when the organism is resistant to narrower agents, to promote use of narrower therapy
Cascade reporting withholds susceptibility data for broader agents unless resistance to narrower agents is confirmed, nudging prescribers toward narrower-spectrum therapy.
Question 7: Which of the following represents an appropriate outcome metric for evaluating an antimicrobial stewardship program?
- Rate of Clostridioides difficile infections per 10,000 patient-days (Correct answer)
- Number of antibiotic classes available in the hospital formulary
- Total number of blood cultures drawn per month
- Percentage of patients with a positive skin test for penicillin
Correct answer: Rate of Clostridioides difficile infections per 10,000 patient-days
C. difficile infection rates are a key clinical outcome metric for ASPs because they reflect the downstream harm of unnecessary broad-spectrum antibiotic use.
CBIC Antimicrobial Stewardship 4
A patient is diagnosed with asymptomatic bacteriuria.
Which ASP recommendation is appropriate for most patients?