Examkin

Soru

Zorluk: OrtaInfectious Diseases

During morning rounds in the intensive care unit, the medical team evaluates a patient recovering from a catheter-associated bloodstream infection. Empiric therapy with intravenous vancomycin and cefepime was initiated three days ago for suspected sepsis. The patient is currently afebrile and hemodynamically stable, and the offending central venous catheter has been removed. Final blood culture results from admission now reveal growth of *Enterococcus faecalis* in two out of two sets. The isolate demonstrates susceptibility to ampicillin, vancomycin, linezolid, and daptomycin. Which of the following is the most appropriate modification to this patient's antimicrobial regimen?

  1. A
    Discontinue cefepime and continue intravenous vancomycin
  2. B
    Discontinue vancomycin and continue intravenous cefepime
  3. C
    Continue the current regimen of intravenous vancomycin and cefepime
  4. Discontinue vancomycin and cefepime, and initiate intravenous ampicillinCevap
  5. E
    Discontinue vancomycin and cefepime, and initiate intravenous daptomycin

Cevap

Discontinue vancomycin and cefepime, and initiate intravenous ampicillin
The correct approach is to discontinue the broad-spectrum empiric regimen and initiate intravenous ampicillin. For *Enterococcus faecalis* infections that are susceptible to ampicillin, beta-lactam therapy (such as ampicillin or penicillin) is the treatment of choice. Ampicillin is preferred over vancomycin because it is highly active, bactericidal, has a narrower spectrum of activity, and helps prevent the development of vancomycin-resistant enterococci (VRE). De-escalating therapy once culture and susceptibility data are available is a core principle of antibiotic stewardship.

Adım Adım Çözüm

1
Identify the pathogen and its susceptibility profile from the blood culture results.
The pathogen is *Enterococcus faecalis*, which is susceptible to ampicillin, vancomycin, linezolid, and daptomycin.
Correct identification and susceptibility testing are required to transition from empiric to targeted therapy.
2
Determine the optimal targeted therapy for susceptible *Enterococcus*.
Ampicillin is the drug of choice for susceptible *Enterococcus faecalis* due to its bactericidal activity and narrow spectrum.
Beta-lactams are preferred over vancomycin for susceptible isolates to ensure optimal efficacy and minimize resistance.
3
Apply principles of antimicrobial stewardship to the current regimen.
The overly broad empiric agents (vancomycin and cefepime) should be discontinued, and targeted therapy with intravenous ampicillin should be initiated.
De-escalating therapy reduces the risk of adverse effects, lowers costs, and prevents the emergence of multidrug-resistant organisms.

Anahtar Kavram

Antimicrobial Stewardship and Enterococcal Bacteremia Management
Bu soruyu puanla

Konular

Infectious Diseases

Bu konudan daha fazla soru