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Antibiotics

Antibiotics in the ICU Part II

Antibiotic Therapy in the Critically Ill

*Please take the quiz below the video to receive credit.

Objectives

Discuss common pathogenic organisms and the classes of antibiotics used to target them
Describe initial empiric antibiotic choices based on location and infection type.
Discuss common mechanisms of resistance and reasons for antibiotic failure.

Articles

Adequate antibiotic therapy prior to ICU admission in patients with severe sepsis and septic shock reduces hospital mortality
Advances in antibiotic therapy in the critically ill
Multi-drug resistance, inappropriate initial antibiotic therapy and mortality in Gram-negative severe sepsis and septic shock: a retrospective cohort study

Lecture

Quiz

Antibiotics Part 1

Name*
First Last
1. Which of the following are the three most common causes of community acquired pneumonia?*
- a. Gram negatives, M. Catarrhalis, S. Aureus
- b. S. pneumoniae, H. influenzae, M. catarrhalis
- c. S. aureus, P. aeruginosa, other gram negatives
- d. M. pnemoniae, Legionella, E. Coli
2. What is the most appropriate antibiotic choice in a patient with NKDA with late HAP as well as other risk factors for multi drug resistance?*
- a. Cefepime, Vancomycin
- b. Ceftriaxone, Azithromycin
- c. Vancomycin, Cefepime, and Flagyl
- d. Vancomycin, Ciprofloxacin
3. What is the most common cause of urinary catheter associated UTI?*
- a. K. pneumoniae
- b. S. aureus
- c. S. epidermidis
- d. E. Coli
4. What is the preferred antibiotic regimen used to cover for suspected bacteremia or catheter associated infection?*
- a. Cefepime 2gm IV q 8 hrs
- b. Ceftriaxone 1gm IV q 24 hrs, Vancomycin renally dosed
- c. Cefepime 2gm IV q 8 hrs, Vancomycin renally dosed
- d. Cefepime 2gm IV q 8 hrs, Linezolid 600mg IV q 12 hrs
5. What is the first line therapy recommended for suspected necrotizing soft tissue infection?*
- a. Vancomycin, piperacillin/tazobactam, and clindamycin
- b. Vancomycin, Flagyl, Clindamycin
- c. Ceftriaxon, Flagyl
- d. Flagyl, Clindamycin
6. What is the antibiotic of choice for known MSSA infection?*
- a. Vancomycin
- b. Cefepime
- c. Linezolid
- d. Oxacillin
7. Which of the following patient populations would be most at risk for developing a pseudomonal infection intra-abdominally and will need broad spectrum ABX coverage?*
- a. Diabetics
- b. Patients who have recently been hospitalized or have been on broad spectrum ABX
- c. The elderly
- d. Bowel perforation
8. Which of the following antibiotics does NOT provide anti-pseudomonal coverage?*
- a. Ertapenem
- b. Piperacillin-tazobactam
- c. Cefepime
- d. Tobramycin
- e. Aztreonam
9. True or false: If a patient is growing out an Enterobacter species in their blood and sensitivities show resistant to cefoxitin, this bug is most likely an ampC producer and should be treated as resistant to all other cephalosporins except cefepime.*
- True
- False
10. Which of the following is NOT a common pathogen associated with ESBL production?*
- A. E. Coli
- B. S. Aureus
- C. Klebsiella spp.
- D. Pseudomonas aeruginosa

Antibiotics in the ICU Part II

*Please take the quiz below the video to receive credit.

Objectives

Apply Vancomycin and aminoglycoside dosing nomograms to patient care
Facilitate the development of patient-specific pharmacokinetic monitoring plans

Articles

Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis
Multidrug-Resistant Pathogens and Pneumonia: Comparing the Trauma and Surgical Intensive Care Units
Gram stain can be used to safely discontinue vancomycin therapy for early pneumonia in the trauma intensive care unit

Lecture

Quiz

Antibiotics Quiz Part II

Name*
First Last
1. When administering Gentamycin or Tobramycin, one should aim to achieve a trough level of:*
- a. 0.5-2 mcg/mL
- b. 2-4 mcg/mL
- c. 4-10 mcg/mL
- d. 10-15 mcg/mL
2. Aminoglycoside concentrates most highly in the:*
- a. Lungs
- b. Muscle
- c. Urine
- d. Bone
3. When measuring trough or peak levels of aminoglycosides, how soon before or after respectively should these levels be obtained?*
- a. 15 minutes
- b. 30 minutes
- c. 45 minutes
- d. 1 hour
4. To use the Hartfort Nomogram, in what time frame following the initial dose of aminoglycosides is the first monitoring level drawn.*
- a. 30 minutes
- b. 1 hour
- c. 6-14 hours
- d. 24 hours
5. What is the half life of Tobramycin and Gentamycin?*
- a. 11-12 hours
- b. 8-9 hours
- c. 5-6 hours
- d. 2-3 hrs
6. The Vancomycin trough goal when treating pneumonia should be:*
- a. >20 mcg/mL
- b. 15-20 mcg/mL
- c. 10-15 mcg/mL
- d. <10 mcg/mL
7. In a patient with necrotizing fasciitis being treated with vancomycin, zosyn, and clindamycin, whose vancomycin trough level returns at 9 mcg/mL, how should the next Vancomycin dose be adjusted.*
- a. Decrease dose interval to next standard interval
- b. Increase dose by 25%, maintain interval
- c. Decrease dose by 25%, maintain interval
- d. Increase interval to next standard level
8. In a patient with stable aminoglycoside or vancomycin levels, how often should maintenance trough levels be checked?*
- a. Daily
- b. Every other day
- c. Every 3 days
- d. Weekly
9. In a patient with CrCl greater than 60mL/min, what initial dose of vancomycin should be written for?*
- a. 20-25mg/kg
- b. 10-15mg/kg
- c. 7mg/kg
- d. 3mg/kg
10. For a patient receiving intermittent hemodialysis, Vancomycin levels should be drawn before dialysis is received, while the next dose of Vancomycin should be given following the completion of hemodialysis.*
- True
- False

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