CIC Antimicrobial Stewardship 2 — Questions and Answers
Question 1: Which metric is most commonly used to measure antibiotic consumption in antimicrobial stewardship programs?
- Days of therapy (DOT) per 1,000 patient-days (Correct answer)
- Number of prescriptions per patient
- Total drug cost per admission
- Length of stay per infection episode
Correct answer: Days of therapy (DOT) per 1,000 patient-days
Days of therapy (DOT) per 1,000 patient-days is the preferred standardized metric for tracking antibiotic consumption because it accounts for multiple agents and dose changes.
Question 2: A patient is started on broad-spectrum antibiotics empirically. What is the stewardship principle that involves narrowing therapy once culture results return?
- De-escalation (Correct answer)
- Escalation
- Cycling
- Mixing
Correct answer: De-escalation
De-escalation is the practice of switching from broad-spectrum to narrow-spectrum antibiotics once the causative organism and its susceptibilities are identified.
Question 3: Which intervention is an example of a 'front-end' stewardship strategy?
- Prospective audit and feedback
- Formulary restriction with prior authorization (Correct answer)
- Post-prescription review
- Infectious disease consultation after 72 hours
Correct answer: Formulary restriction with prior authorization
Formulary restriction with prior authorization is a front-end strategy that requires approval before an antibiotic is dispensed, preventing unnecessary prescriptions proactively.
Question 4: Procalcitonin (PCT) guidance in antimicrobial stewardship is primarily used to:
- Identify the specific causative pathogen
- Guide antibiotic discontinuation in respiratory infections (Correct answer)
- Select the appropriate antibiotic class
- Determine the correct antibiotic dose
Correct answer: Guide antibiotic discontinuation in respiratory infections
PCT is a biomarker that rises with bacterial infections and falls as they resolve, making it useful for guiding safe discontinuation of antibiotics in respiratory tract infections.
Question 5: What is the primary goal of antimicrobial cycling (rotation) strategies?
- Reduce antibiotic costs
- Prevent the emergence and spread of resistance by rotating drug classes (Correct answer)
- Simplify prescribing decisions
- Decrease the number of available antibiotics on formulary
Correct answer: Prevent the emergence and spread of resistance by rotating drug classes
Antimicrobial cycling rotates antibiotic classes in a scheduled manner to reduce selective pressure from any single agent and theoretically limit resistance development.
Question 6: Which organism is the primary target of vancomycin stewardship efforts in healthcare settings?
- Gram-negative rods
- Methicillin-resistant Staphylococcus aureus (MRSA) (Correct answer)
- Clostridioides difficile
- Candida albicans
Correct answer: Methicillin-resistant Staphylococcus aureus (MRSA)
Vancomycin is the primary treatment for MRSA infections, and inappropriate use drives vancomycin-resistant enterococci (VRE) emergence, making MRSA the central stewardship target for this agent.
Question 7: An ASP team recommends switching a patient from IV to oral antibiotics on day 3 of treatment. This intervention is known as:
- Antibiotic timeout
- IV-to-oral (IVPO) conversion (Correct answer)
- De-escalation
- Antibiotic cycling
Correct answer: IV-to-oral (IVPO) conversion
IV-to-oral conversion is a key stewardship intervention that reduces costs, IV line complications, and hospital length of stay when a patient can tolerate oral medications.
CIC Antimicrobial Stewardship 2
Which metric is most commonly used to measure antibiotic consumption in antimicrobial stewardship programs?