CIC - Certification in Infection Prevention and Control Antimicrobial Stewardship Questions and Answers — Questions and Answers
Question 1: A hospital's antimicrobial stewardship program is evaluating its antibiotic consumption data. Which of the following metrics is most recommended for tracking and reporting because it reflects the number of patients exposed to an antibiotic, regardless of the dose administered?
- Defined Daily Dose (DDD)
- Days of Therapy (DOT) (Correct answer)
- Grams of antibiotic purchased
- Prescribed Daily Dose (PDD)
Correct answer: Days of Therapy (DOT)
Days of Therapy (DOT) is the preferred metric for measuring antibiotic use. It is defined as the number of days a patient receives a specific antibiotic, regardless of the dose. This makes it a more accurate reflection of patient exposure compared to the Defined Daily Dose (DDD), which is a standardized measure that may not reflect actual prescribed doses, especially in cases of renal dose adjustments or in pediatric populations.
Question 2: An Infection Preventionist (IP) is a core member of the Antimicrobial Stewardship Committee. The committee is reviewing a sharp increase in hospital-onset *Clostridioides difficile* infections (CDI) on the oncology unit. The stewardship pharmacist has already identified high usage rates of broad-spectrum antibiotics. What is the most critical and unique contribution the IP can make to the committee's investigation?
- Developing a new institutional guideline for empiric antibiotic selection.
- Auditing hand hygiene compliance and environmental cleaning practices on the unit. (Correct answer)
- Providing an educational in-service to physicians about the risks of fluoroquinolones.
- Analyzing the cost-effectiveness of switching to a different primary antibiotic.
Correct answer: Auditing hand hygiene compliance and environmental cleaning practices on the unit.
While all options are related to stewardship, the IP's primary expertise is in the prevention and control of infections through non-pharmacological means. In a CDI outbreak, the IP's most critical role is to investigate potential breakdowns in infection prevention practices, such as hand hygiene, use of personal protective equipment, and environmental disinfection, which are the primary modes of *C. difficile* transmission. This complements the pharmacist's focus on antibiotic use.
Question 3: Which of the following is a primary function of a facility-specific antibiogram for an antimicrobial stewardship program?
- To track the daily cost of antimicrobial agents used in the facility.
- To mandate which antibiotics individual physicians are allowed to prescribe.
- To monitor individual patient response to a specific antibiotic regimen.
- To guide the selection of effective empiric antimicrobial therapy based on local resistance patterns. (Correct answer)
Correct answer: To guide the selection of effective empiric antimicrobial therapy based on local resistance patterns.
A facility-specific antibiogram is a summary of local antimicrobial susceptibility patterns for common pathogens. Its primary purpose is to help clinicians choose the most effective empiric antibiotic—the initial therapy started before culture and susceptibility results are known—by providing data on which drugs are most likely to be effective against bacteria circulating within that specific hospital or community.
Question 4: According to the CDC's Core Elements of Hospital Antibiotic Stewardship Programs, the strategy of reviewing a patient's antibiotic therapy after 48-72 hours to assess the need for adjustment, de-escalation, or discontinuation is best described as:
- Formulary Restriction
- Preauthorization
- An 'Antibiotic Time-Out' (Correct answer)
- Reporting and Tracking
Correct answer: An 'Antibiotic Time-Out'
An 'Antibiotic Time-Out' is a key stewardship action that involves a formal reassessment of a patient's antibiotic regimen at a set point, typically 48-72 hours after initiation. This allows for the incorporation of new clinical and microbiological data to determine if the current therapy is still indicated, if a narrower-spectrum agent can be used (de-escalation), or if the antibiotic can be stopped altogether.
Question 5: A nurse on a medical-surgical unit reports that an 85-year-old female patient with an indwelling urinary catheter has cloudy, foul-smelling urine and a positive urinalysis for bacteria and pyuria. The patient has no fever, no suprapubic tenderness, and no change in mental status. Based on antimicrobial stewardship principles, what is the most appropriate next step?
- Advise that this represents asymptomatic bacteriuria (ASB), which does not require antibiotic treatment. (Correct answer)
- Recommend starting empiric antibiotics immediately pending a urine culture.
- Suggest obtaining a urine culture and sensitivity before making a treatment decision.
- Instruct the nurse to replace the indwelling catheter and send the catheter tip for culture.
Correct answer: Advise that this represents asymptomatic bacteriuria (ASB), which does not require antibiotic treatment.
The patient lacks signs and symptoms of a urinary tract infection (UTI), such as fever or pain. The presence of bacteria and pyuria in the urine of a catheterized, asymptomatic patient is defined as asymptomatic bacteriuria (ASB). Guidelines strongly recommend against treating ASB in most populations (except for pregnancy or prior to certain urologic procedures) because treatment provides no benefit and increases risks of adverse drug events, *C. difficile* infection, and antimicrobial resistance.
Question 6: An Infection Preventionist is helping the Antimicrobial Stewardship Program develop educational materials for nursing staff. Which of the following is a key stewardship-related action that should be emphasized for the nursing staff to perform?
- Deciding on the final antibiotic selection for complex infections.
- Questioning the indication and duration for antibiotic orders during patient assessments. (Correct answer)
- Placing orders for antibiotic serum drug level monitoring.
- Approving or denying requests for restricted antimicrobial agents.
Correct answer: Questioning the indication and duration for antibiotic orders during patient assessments.
Nurses play a vital role in antimicrobial stewardship by being at the bedside. A key action is to integrate stewardship principles into their daily workflow by questioning the documented indication, dose, and duration for antibiotic orders, and communicating any concerns or changes in patient status to the prescriber or pharmacist. This helps ensure antibiotics are continuously evaluated for appropriateness. The other options are responsibilities of physicians or pharmacists.
