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PID > Antimicrobial Resistance and Susceptibility > Flashcards

Antimicrobial Resistance and Susceptibility Flashcards

1
Q

Which is the most important superbug associated with hospitals?

A

Carbapenem- resistant K. pneumoniae

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2
Q

Which of the following are most common in hospitals and the community, including livestock and companion animals?

a. Methicillin-resistant S. aureus (MRSA)
b. ESBL-producing E. coli
c. Multidrug resistant S. pneumoniae
d. A and C
e. A and B
f. B and C

A

e. A and B

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3
Q

True/ False. Antibiotic therapy is only recommended for invasive infections.

A

True.

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4
Q

Which drugs have a resistance to Salmonella?

A

Cephalosporins or fluoroquinolones

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5
Q

Which drugs have a resistance to Campylobacter?

A

Macrolides or fluoroquinolones

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6
Q

True/ False. MDR (multi drug resistant) bacteria are usually resistant to all drugs except cephalosporins.

A

False. They are resistant to cephalosporins

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7
Q

Which of the following are beta-lactam resistant?

a. MRSA
b. MRSP
c. ESBL
d. All the above

A

d. All the above

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8
Q

What does MRSA stand for?

A

Methicillin Resistant Staphylococcus Aureus

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9
Q

True/False. MRSA and MRSP have the lowest affinity to penicillins and cephalosporins.

A

True.

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10
Q

Which of the following MRSA is associated with livestock?

a. CC8
b. CC22
c. CC398
d. CC9

A

c. CC398

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11
Q

What does MRSP stand for?

A

Methicillin Resistant Staphylococcus Pseudintermedius

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12
Q

True/False. Approximately 70% of MRSP cases are skin and wound postsurgical infections acquired in the clinic.

A

True.

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13
Q

What does ESBL stand for?

A

Extended Spectrum Beta Lactamase

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14
Q

What is ESBL?

A

It is an enzyme hydrolyzing/inactivating most Beta lactams produced by gram-negative bacteria

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15
Q

What is the only beta lactam ESBL does not hydrolyze/inactivate?

A

Carbapenems

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16
Q

True ESBLs are susceptible to B- lactamase inhibitors such as _____.

A

Clavulanic acid

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17
Q

What are the three main ESBL classes?

A

CTX-M
SHV
TEM

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18
Q

Which is the most common type of ESBL in animals?

a. CMY-2
b. CTX-M-2
c. CTX-M-1
d. CMY-1

A

c. CTX-M-1

19
Q

A false ESBL (resistant to Beta-lactamase inhibitors) is widespread in small animals and limited to poultry

A

CMY-2

20
Q

Which ESBL type can be transferred horizontally from E.coli livestock to E.coli in humans?

A

CTX-M-1

21
Q

How do bacteria acquire resistance?

A

Mutation

Horizontal gene transfer by transformation, transduction, and conjugation

22
Q

What is transduction?

A

A transfer mediated by phage delivery

23
Q

True/False. Antimicrobial resistance is a qualitative property.

A

False. Its a quantitative property

24
Q

What are the two dilution methods for AST?

A

Broth dilution tests

Agar dilution tests

25
Q

What are the two agar diffusion methods for AST?

A

Disk/tablet diffusion test (semi-quantitative)

Gradient diffusion E test (quantitative)

26
Q

___ is the lowest concentration that inhibits completely growth of the test strain.

A

MIC (minimum inhibitory concentration)

27
Q

What is MBC (Minimum bactericidal concentration)

A

The lowest concentration that kills the test strain

28
Q

True/False. Diffusion method has a high reproducibility and robustness, whereas dilution method has a medium reproducibility and robustness.

A

False. Diffusion method has a MEDIUM reproducibility and robustness, whereas dilution method has a HIGH reproducibility and robustness.

29
Q

Is the dilution method more expensive or cheaper than the diffusion method?

A

More expensive than diffusion

30
Q

True/False. Standardization and quality control are required for reproducibility of AST.

A

True.

31
Q

How is quality control done?

A
  • Reference strains of different species are routinely included in the testing (every day, or every week)
  • MIC of the reference strain has to fall within a given range
  • If not within a range the test will not be valid and should be repeated
32
Q

What is the incubation period for the AST laboratory test?

A

35 Degrees C for 16-20 hours

33
Q

What is a breakpoint?

A

A drug-specific value to interpret the results of susceptibility testing and determine if an antibacterial is potentially useful in the treatment of a bacterial infection.

34
Q

A strain is defined as ___ by a level of antimicrobial activity associated with a high likelihood of therapeutic success.

A

Susceptible

35
Q

A strain is defined as ___ by a level of antimicrobial activity associated with a high likelihood of therapeutic failure.

A

Resistant

36
Q

What is the standard range of a susceptible MIC? Resistant MIC?

A

less than or equal to 4 = susceptible

greater than or equal to 32 = resistant

37
Q

What data is needed for setting breakpoints?

A
  1. MIC distribution to determine MIC value that separates the WT population from resistant populations
  2. PD/PK index
  3. Clinical and bacteriological outcome data from clinical trials
38
Q

When is a strain defined as wild type (WT) for a species?

A

By the absence of any acquired resistance genes and/or mutations increasing the MIC of the antimicrobial agent

39
Q

If a strain is ___ for AST, it is inhibited at blood concentrations achieved by standard dosage of the drug.

A

Susceptible

40
Q

Clinical efficacy is possible if the strain infects body sites where the drug concentrates or if the dosage can be increased compared to standard dosage.

A

Intermediate

41
Q

Resistant for AST

A

The strain is NOT inhibited at blood concentrations achieved by standard dosage of the drug.

42
Q

What are the two drugs used for detection of MRSA/MRSP?

A

Oxacillin

Cefoxitin

43
Q

True/False. Strains resistant to oxacillin/cefoxitin should be regarded as susceptible to all beta lactams.

A

False. They are resistant to Beta lactams

PID (8 decks)

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