CBIC Antimicrobial Stewardship 5 — Questions and Answers
Question 1: Which of the following is a core element of hospital antibiotic stewardship programs as recommended by The Joint Commission?
- Leadership commitment demonstrated by dedicating necessary human, financial, and information technology resources (Correct answer)
- Restricting all antibiotic prescribing to physicians only, excluding APRNs and PAs
- Requiring infectious disease approval for every antibiotic order within 1 hour
- Eliminating all broad-spectrum antibiotics from the hospital formulary
Correct answer: Leadership commitment demonstrated by dedicating necessary human, financial, and information technology resources
TJC's ASP standards require leadership commitment, including accountability, drug expertise, action, tracking, reporting, and education as core elements.
Question 2: A patient with MRSA bacteremia is started on vancomycin. Which ASP-supported monitoring practice is most important?
- Therapeutic drug monitoring using AUC/MIC-guided dosing rather than trough-only monitoring (Correct answer)
- Checking trough levels only once at steady state and not adjusting thereafter
- Switching to oral vancomycin after 3 days regardless of clinical response
- Discontinuing vancomycin as soon as blood cultures clear once
Correct answer: Therapeutic drug monitoring using AUC/MIC-guided dosing rather than trough-only monitoring
AUC/MIC-guided vancomycin dosing (targeting AUC 400-600 mg·h/L) reduces nephrotoxicity and treatment failure compared to trough-only monitoring.
Question 3: Which of the following best describes 'antibiotic heterogeneity' as a stewardship strategy?
- Intentionally varying the antibiotic agents used across a unit to reduce selective pressure for resistance to any single drug (Correct answer)
- Using only one antibiotic class across the entire hospital to simplify protocols
- Alternating between two antibiotics on a fixed weekly cycling schedule
- Prescribing combination therapy for all gram-negative infections
Correct answer: Intentionally varying the antibiotic agents used across a unit to reduce selective pressure for resistance to any single drug
Antibiotic heterogeneity (also called mixing) aims to reduce clonal expansion of resistant organisms by diversifying drug selection pressure across patients.
Question 4: When evaluating a positive respiratory culture from a ventilated patient, which scenario best represents colonization rather than infection requiring treatment?
- Growth of Candida albicans in a BAL specimen from a patient with no clinical signs of pneumonia and normal oxygenation (Correct answer)
- Growth of Pseudomonas aeruginosa from BAL in a patient with new infiltrate, fever, and increased secretions
- Positive blood culture for Staphylococcus aureus drawn from a peripheral vein
- Positive urine culture with >100,000 CFU/mL in a symptomatic patient with dysuria
Correct answer: Growth of Candida albicans in a BAL specimen from a patient with no clinical signs of pneumonia and normal oxygenation
Candida in respiratory cultures almost always represents colonization; antifungal treatment for respiratory Candida is not recommended in non-immunocompromised ventilated patients.
Question 5: Which of the following is the most important reason to obtain blood cultures BEFORE starting antibiotics?
- To identify the causative pathogen and guide de-escalation to targeted narrow-spectrum therapy (Correct answer)
- To satisfy hospital documentation requirements for billing purposes
- To determine if the patient needs isolation precautions
- To assess whether the patient has adequate venous access
Correct answer: To identify the causative pathogen and guide de-escalation to targeted narrow-spectrum therapy
Pre-treatment blood cultures provide the pathogen identification and susceptibility data needed to de-escalate from empiric broad-spectrum therapy to targeted narrower agents.
Question 6: Which of the following antibiotic stewardship interventions has been shown to reduce surgical site infection (SSI) rates?
- Ensuring surgical prophylaxis is given within 60 minutes before incision and discontinued within 24 hours post-operatively (Correct answer)
- Continuing prophylactic antibiotics for 72 hours after all surgeries
- Using vancomycin as the sole prophylactic agent for all surgical procedures
- Administering prophylaxis only when the patient requests it
Correct answer: Ensuring surgical prophylaxis is given within 60 minutes before incision and discontinued within 24 hours post-operatively
Timely administration (within 60 minutes pre-incision) and short duration (≤24 hours) of surgical prophylaxis are evidence-based practices that optimize SSI prevention while minimizing resistance selection.
Question 7: Which of the following best describes the role of clinical decision support systems (CDSS) in antimicrobial stewardship?
- Provide real-time alerts and recommendations at the point of prescribing to guide antibiotic selection, dosing, and duration based on patient-specific data (Correct answer)
- Automatically discontinue all antibiotic orders after 72 hours without clinician input
- Replace the need for an infectious disease pharmacist in the ASP team
- Generate billing codes for antibiotic-related hospital stays
Correct answer: Provide real-time alerts and recommendations at the point of prescribing to guide antibiotic selection, dosing, and duration based on patient-specific data
CDSS tools integrated into the EHR can flag inappropriate prescribing, suggest de-escalation, alert to drug-drug interactions, and recommend dose adjustments in real time.
CBIC Antimicrobial Stewardship 5
Which of the following is a core element of hospital antibiotic stewardship programs as recommended by The Joint Commission?