CIC Antimicrobial Stewardship 4 — Questions and Answers
Question 1: A stewardship program wants to reduce carbapenem use. Which organism's rising prevalence would most urgently justify this intervention?
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Carbapenem-resistant Enterobacteriaceae (CRE) (Correct answer)
- Vancomycin-resistant Enterococcus (VRE)
- Candida auris
Correct answer: Carbapenem-resistant Enterobacteriaceae (CRE)
CRE are resistant to carbapenems and most other antibiotics, leaving very limited treatment options; stewardship to reduce carbapenem use is essential to slow CRE emergence and spread.
Question 2: Which stewardship strategy involves reviewing antibiotic prescriptions after they are dispensed and providing recommendations to prescribers?
- Prior authorization
- Formulary restriction
- Prospective audit and feedback (PAF) (Correct answer)
- Antibiotic rotation
Correct answer: Prospective audit and feedback (PAF)
Prospective audit and feedback involves pharmacists or infectious disease physicians reviewing active antibiotic orders and providing real-time recommendations to prescribers without requiring prior approval.
Question 3: What is the recommended standard duration of therapy for uncomplicated community-acquired pneumonia (CAP) in a hospitalized patient according to current guidelines?
- 3-5 days
- 5-7 days (Correct answer)
- 10-14 days
- 21 days
Correct answer: 5-7 days
Current IDSA/ATS guidelines recommend 5-7 days for hospitalized CAP patients who respond clinically, as shorter courses are as effective as longer durations for uncomplicated cases.
Question 4: In the context of stewardship, 'inappropriate antibiotic use' includes all of the following EXCEPT:
- Treating viral infections with antibiotics
- Using narrow-spectrum antibiotics for confirmed susceptible organisms (Correct answer)
- Continuing antibiotics beyond recommended duration
- Dosing antibiotics below therapeutic levels
Correct answer: Using narrow-spectrum antibiotics for confirmed susceptible organisms
Using narrow-spectrum antibiotics for confirmed susceptible organisms is the ideal stewardship outcome — matching therapy to the pathogen appropriately is correct practice, not inappropriate use.
Question 5: Which of the following best describes antimicrobial stewardship in long-term care facilities (LTCFs)?
- LTCFs do not require stewardship programs as they treat less severe infections
- LTCFs must implement stewardship programs and are a major reservoir for resistant organisms (Correct answer)
- Stewardship in LTCFs focuses exclusively on antifungals
- LTCFs only need to restrict fluoroquinolones
Correct answer: LTCFs must implement stewardship programs and are a major reservoir for resistant organisms
LTCFs are required by CMS to have antibiotic stewardship programs and are recognized as major reservoirs for resistant organisms like MRSA, VRE, and ESBL-producers due to frequent antibiotic use.
Question 6: Which clinical scenario represents appropriate antibiotic stewardship?
- Prescribing vancomycin empirically for all febrile patients
- Continuing broad-spectrum antibiotics for 14 days regardless of culture results
- Discontinuing antibiotics when cultures confirm a viral etiology (Correct answer)
- Prescribing fluoroquinolones for asymptomatic bacteriuria in elderly patients
Correct answer: Discontinuing antibiotics when cultures confirm a viral etiology
Stopping antibiotics when cultures confirm a viral etiology is the correct stewardship action, as antibiotics have no efficacy against viruses and continuing them only drives resistance.
Question 7: Which of the following antibiotic properties makes it suitable for IV-to-oral conversion early in therapy?
- Low oral bioavailability (<20%)
- High oral bioavailability (>80%) (Correct answer)
- Narrow spectrum of activity
- Requirement for therapeutic drug monitoring
Correct answer: High oral bioavailability (>80%)
High oral bioavailability (>80%) means serum levels achieved orally are comparable to IV administration, making early conversion safe and effective without compromising efficacy.
CIC Antimicrobial Stewardship 4
A stewardship program wants to reduce carbapenem use.
Which organism's rising prevalence would most urgently justify this intervention?