Infectious Diseases I

antibiotic regimen is best for the likely causative

pathogen(s) of K.P.’s suspected VAP?

T.D. is a 57-year-old man admitted to the medical

intensive care unit (MICU) with severe hyperosmo-

lar hyperglycemic syndrome. A subclavian central

venous catheter (CVC) is placed on his arrival at the

MICU. On ICU day 4, T.D. has a temperature of

102.7°F (39.2°C) and a WBC of 17 x 103 cells/mm3.

The nurse notes new-onset erythema at the catheter

site. After an appropriate diagnostic workup, it is

decided to initiate empiric antibiotic therapy for

a suspected central line–associated bloodstream

infection (CLABSI). Which agent is best for empiric

therapy?

D.G., a 31-year-old woman, presents to the MICU

with severe respiratory failure and acute respiratory

distress syndrome (ARDS) requiring intubation after

48 hours of malaise, fever, and myalgias. The nasal

washing sent by the emergency department (ED) for

rapid diagnostic testing is positive for influenza A.

The local prevalence of subtype 2009 H1N1 is high.

Which agent would be most appropriate for initial

treatment of D.G.’s severe influenza?

T.S. is a 79-year-old woman admitted to the MICU

for respiratory failure and severe community-

acquired pneumonia. T.S. has had a urethral catheter

in place for 6 days while mechanically ventilated

on fentanyl infusion and intermittent haloperidol

as needed for pain and delirium, respectively. This

morning, T.S. had a temperature of 101.6°F (38.7°C)

and an elevation in WBC to 16 x 103 cells/mm3;

she is hemodynamically stable. Blood and urine

cultures are sent. Urinalysis reveals significant pyuria.

Which pathogen is most likely to cause a catheter-asso-

ciated urinary tract infection (CAUTI) in T.S.?

K.D. is a 59-year-old man admitted to the surgi-

cal intensive care unit (SICU) after an emergency

operation and partial bowel resection with primary

anastomosis for mid-small bowel necrosis and perfo-

ration likely secondary to severe peripheral vascular

disease. During the operation, significant peritoneal

contamination with evidence of gross peritonitis

was noted together with persistent hypotension and

need for vasopressors. K.D. received perioperative

cefazolin and metronidazole. Which empiric antibi-

otic regimen would be most appropriate for K.D.?

T.M. is a 42-year-old man with chronic alcoholism

who presents to the ED with severe epigastric pain

and serum lipase greater than 10 times the upper

limit of normal. The resident orders a computed

tomography (CT) scan, which reveals necrosis

affecting almost 40% of the pancreas but no abnor-

mal fluid collections or evidence of abscess. T.M. is

febrile and tachycardic, and his WBC is elevated.

T.M.’s urine output is less than 0.5 mL/kg/hour, sug-

gestive of hypovolemia. Which best describes the

role of antibiotic therapy for T.M. at this time?

sepsis and likely pancreatic infection.

aration for pancreatic debridement.

vent infection of necrotic tissue.