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Clinical Microbiology 2 > 6. Multi-Drug Resistant Organisms > Flashcards

6. Multi-Drug Resistant Organisms Flashcards

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1
Q

Combination therapy to treat Enterococcus infections?

A

Ampicillin-sulbactam
Amoxicillin-clavulanate
Piperacillin-tazobactam

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2
Q

What 2 types organisms is the CarbaNP test for?

A

Enterobacteriaceae
Pseudomonas aeruginosa

that are I or R to 1+ carbapenem

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3
Q

ESBL confirmation test

A

Phenotypic confirmatory test

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4
Q

Often used against MRSA, but rapid development of resistance => not recommended for monotherapy

A

Rifampin

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5
Q

Most common carbapenemase?

A

Class A (KPC)

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6
Q

Test that predicts mecA-mediated resistance in S. aureus

A

30 ug cefoxitin disc

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7
Q

Methicillin resistant Staphylococcus aureus are strains that have MICs to oxacillin = __ ug/mL.

A

4

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8
Q

Difference between G+ and G- B-lactamases?

A

G+ = exoenzymes secreted by organism

G- = concentrated in periplasmic space; not secreted

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9
Q

When is inducible B-lactamase resistance in staph tested for?

A

whenever a staph tests “S” to penicillin

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10
Q

Next step after staph tests ‘S’ for pencillin?

A

Test for inducible B-lactamase

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11
Q

3rd gen = R
1st gen = S
What does this suggest?

A

ESBL

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12
Q

Patient screening for MRSA - appropriate anatomical sites?

A
  • Anterior nares (nostrisl)
  • Axillae (armpits)
  • Wounds, drain sites
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13
Q

Penicillin zone edge test ‘sharp zone edge’ interpretation?

‘Fuzzy zone dge’?

A

Sharp = B-lactamase production POS

Fuzzy = NEG

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14
Q

MRSA strains are _____________: have both “S” and “R” subpopulations

A

hetero-resistant

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15
Q

Purpose of 4% salt MHA plate

A

MRSA strains grow well at higher [salt] => pushes expression of mecA gene

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16
Q

Used in the cefinase test for induced hyper beta lactamase production

A

1 ug oxacillin disc

17
Q

2 types of MRSA screening media?

A

MSAO - mannitol salt agar w/ oxacillin

  • mannitol fermenters = possible MRSA = yellow
  • CoNS = white/pink

Chromogenic agars

18
Q

4 penicillinase-labile penicillins

A

Penicillin
Amoxicillin
Ampicillin
Piperacillin

19
Q

Patient screening for VRE - appropriate anatomical sites?

A
  • Stool, perineum/rectum
  • Neck, groin (neonates)

Less common = urine, open wounds, drain sites

20
Q

Used in the screen test for oxacillin resistance in staph

A

MH agar w/ 4% NaCl and 6 ug/mL oxacillin

21
Q

S. aureus strains that are R to oxacillin but S to amoxicillin/clavulanic acid

A

BORSA

22
Q

Organism that shows some resistance to oxacillin (usually “I” MICs) are called…?

A

BORSA

23
Q

New subclass of cephalosporin w/ anti-MRSA activity

A

Ceftaroline

24
Q

3 types of VRE screening media?

A

Chromagar plates

BEAV - brown-black colonies w/ dark halo

VRE selective broth - look for evidence of black/grey growth, subculture to agar

25
Q

4 common B-lactamsae inhibitor combo drugs

A

Amoxicillin/clavulanic acid

Ticaricillin/clavulanic acid

Piperacillin/tazobactam

Ampicillin/sulbactam

26
Q

Why should isolates of enterococci from sterile sites have nitrocefin beta-lactamase test done as well as routine KB susceptibility testing?

A

Resistance to ampicillin and penicillin due to B-lactamases cannot reliably be predicted by routine KB or MIC methods

27
Q

MRSA treatment alternatives - particularly if community-acquired and non-invasive

A

Tetracyclines, SXT

28
Q

3 penicillinase-stable (resistant to B-lactamase) penicillins

A

Oxacillin
Cloxacillin
Methicillin
Nafcillin

29
Q

Detection of inducible AmpC B-lactamases?

A

Cefoxitin = primary screen

30
Q

How is low level vancomycin resistance in Enterococci detected?

A

BHI w/ 6ug/mL vancomycin (part of routine AST for all enterococci)

31
Q

3 class B carbapenemases

A

NDM-1
IMP-type
VIM

32
Q

Test that must be done for all BORSA isolates?

A

B-lactamase test

33
Q

Beta lactamase test common uses what antimicrobial?

A

Nitrocefin

34
Q

Purpose of mCIM vs eCIM?

A

mCIM - detect carbapenemases

eCIM - differentiates metallo-B-lactamases from serine carbapenemases (only interpreted if mCIM POS)

35
Q

Confirmation of inducible AmpC B-lactamases?

A

E-test AmpC strip => uses cefotetan (less sensitive than cefoxitin)

Cefoxitin-cloxacillin double-disk synergy (CC-DDS)
- cloxacillin inhibits AmpC B-lactamases

36
Q

The 4 drugs that may be used to screen for ESBL producers?

A
  • Ceftazidime
  • Cefotaxime
  • Azthreonam
  • Ceftriaxone

Clinical Microbiology 2 (14 decks)

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