A 72-year-old woman with CKD and type 2 diabetes had a femoral neck fracture repair and was intubated for 5 days. On day 6 she develops fever, thick sputum, reduced breath sounds and basal crackles. CXR shows a new right lower lobe infiltrate. WBC and creatinine are elevated. She had been on cefazolin. What is the best next step?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: C. Start meropenem + linezolid
New infiltrate, fever and purulent sputum after >48 h of mechanical ventilation = ventilator-associated pneumonia (VAP), typically Pseudomonas/MRSA, especially after prior antibiotics (cefazolin). Empiric VAP therapy needs an anti-pseudomonal β-lactam (e.g. meropenem) PLUS an anti-MRSA agent (vancomycin or linezolid) – option C. Vancomycin alone (B) gives no Gram-negative/Pseudomonas cover, and ceftriaxone/ampicillin-sulbactam regimens (A, D) are CAP regimens.
ليش كل خيار صح أو غلط
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A
ليش غلط
Beta-lactam plus a macrolide (the notes list amoxicillin-sulbactam + azithromycin) is the inpatient community-acquired pneumonia regimen, not the hospital/ventilator-acquired one.
✓ Pneumonia (1).pdf · p. 5 -
B
ليش غلط
Vancomycin covers only the MRSA part. VAP regimens also need an antipseudomonal beta-lactam, so vancomycin alone leaves Pseudomonas uncovered.
✓ Pneumonia (1).pdf · p. 6 -
C
ليش صح
VAP needs combination therapy: an antipseudomonal beta-lactam (meropenem is among those listed) plus an anti-MRSA drug (vancomycin or linezolid).
✓ Pneumonia (1).pdf · p. 6 -
D
ليش غلط
Ceftriaxone-based therapy is the CAP regimen (S. pneumoniae and atypicals). Hospital-acquired pneumonia is mainly Pseudomonas and Staph aureus, so it needs anti-pseudomonal and anti-MRSA cover.
✓ Inefctious Diseases 🦠.pdf · p. 6
- المصدر
- Pneumonia (1).pdf · p. 6
- المحاضرة
- Pneumonia · Pulmonology · Module B
- ظهر في
- MED42 Compre B