Invasive Bacterial and Fungal Infections: Ensuring Guideline-Based Treatment Pre-Test Survey

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Invasive Bacterial and Fungal Infections: Ensuring Guideline-Based Treatment Pre-Test

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1.	According to the 2009 Infectious Diseases Society of America (IDSA) Treatment Guidelines, which of the following would be considered appropriate first-line therapy for candidemia in the lower-risk nonneutropenic patient?*
	Fluconazole 400 mg/day
	Fluconazole 800-mg (12-mg/kg) loading dose; then 400 mg (6 mg/kg/day)
	Voriconazole 6 mg/kg every (Q) 12 hours x 2 doses then 3 mg/kg Q 12 hours
	Amphotericin B 0.7 mg/kg/day

2.	According to the 2009 IDSA Treatment Guidelines, which of the following regimens would be preferred in patients with neutropenia who develop candidemia on fluconazole prophylaxis?*
	High-dose fluconazole 12 mg/kg/day
	Voriconazole 4 mg/kg Q 12 hours
	Echinocandin (anidulafungin, caspofungin, and micafungin)
	Combination fluconazole 12 mg/kg/day + lipid amphotericin B 3 mg/kg/day

3.	Treatment of asymptomatic candiduria is not recommended unless the:*
	Patient is neutropenic.
	Patient has urological manipulations/obstructions.
	Patient is a low–birth-weight infant.
	All of the above

4.	Antimicrobial therapy for more than 24 hours would be most appropriate for which of the following patients?*
	A 63-year-old man undergoing an elective right colon resection for a large villous adenoma, who has a poor bowel preparation, and significant intraoperative contamination of the peritoneal cavity with liquid stool
	A 19-year-old man undergoing an emergency laparotomy immediately after presentation in the emergency department for a gunshot injury to the abdomen, resulting in an injury to the sigmoid colon and contamination of the peritoneal cavity with solid feces
	A 74-year-old woman undergoing an emergency laparotomy for necrotic but nonperforated small bowel secondary to strangulation in an incisional hernia
	A 45-year-old woman undergoing laparotomy for a small bowel injury sustained 3 days previously as a result of blunt abdominal trauma (domestic violence)
	A 36-year-old man undergoing laparoscopic patching of a perforated duodenal ulcer who had developed sudden, severe, abdominal pain with peritoneal signs 16 hours previously

5.	Which of the following regimens would be least appropriate for the treatment of a patient with perforated appendicitis?*
	Moxifloxacin alone
	Cefuroxime plus metronidazole
	Cefepime plus metronidazole
	Ertapenem alone
	Ciprofloxacin plus metronidazole

6.	Which of the following statements regarding the microbiology of intra-abdominal infections is FALSE?*
	Enterococcus sp is the most frequently isolated gram-positive aerobic coccus from peritoneal cultures.
	Escherichia coli is the aerobic organism most frequently isolated from peritoneal cultures.
	Resistance of E coli to ampicillin/sulbactam and to fluoroquinolones is frequently identified in isolates from patients with both nosocomial and community-acquired intra-abdominal infections.
	Bacteroides fragilis is the most frequently identified anaerobic organism with these infections.
	Intra-abdominal infections are generally polymicrobial.

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