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.