Selecting Effective Treatment in the Antibiotic-Resistant Patient Population CME/CE

Marin H. Kollef, MD, FCCP; David Paterson, MD, PhD Author Information and Disclosures

Release Date: March 26, 2008; Valid for credit through March 26, 2009

Credits Available
Physicians - maximum of 1.0 AMA PRA Category 1 Credit(s)™ for physicians;
Nurses - 1.0 nursing contact hours (1.0 contact hours are in the area of pharmacology)

To participate in this internet activity: (1) review the target audience, learning objectives, and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation; (4) view/print certificate View details.

Contents of This CME/CE Activity

  1. Introduction
  2. David B. - This 47-year-old man who is status post renal transplant 3 years ago had a recent episode of severe diverticulitis treated empirically with meropenem and vancomycin. Blood cultures were negative; there was no abscess to aspirate, so the vancomycin was stopped at day 7 due to clinical resolution. The intravenous meropenem was continued, with plans to complete a 10-day course.
  3. Reba S. - This 57-year-old woman with a recent transverse colectomy and several trips back to the operating room for management of an anastomotic leak for colon cancer has ongoing fever and leukocytosis despite piperacillin/tazobactam. She has tolerated her postoperative medications well and denies diarrhea, skin, respiratory, intravenous site, or urinary symptoms.
  4. Donald S. - Previously healthy, 67-year-old, retired laborer presented 3 weeks ago to the emergency department confused and somnolent several hours after falling from a ladder. After prompt evacuation of a subdural hematoma and a period of ventilator dependence, he developed ventilator-associated pneumonia due to Serratia marcescens 1 week later. Two days ago, after completing his antibiotics and being weaned from the ventilator, he developed adult respiratory distress syndrome (ARDS), fever, and leukocytosis following a 3-unit upper gastrointestinal hemorrhage. Suctioned sputum revealed moderate polymorphonuclear neutrophilic leukocytes with gram-negative bacilli, prompting the clinician to initiate empirical antibiotics with a carbapenem and vancomycin after drawing blood cultures, changing the central venous catheter (CVC) and culturing the tip, and scheduling a diagnostic bronchoscopy. A spiral computed tomographic (CT) scan of the lung showed no evidence of pulmonary embolism. There has been slight general improvement in the past 48 hours, and he is requiring much less positive end-expiratory pressure.

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Wyeth
Learning Objectives

Upon completion of this activity, participants will be able to:

  1. Identify appropriate empirical treatment strategies when managing patients with antibiotic-resistant nosocomial infections
  2. Identify the most recent advances in antibiotic therapy against drug-resistant bacteria
  3. Discuss the various avenues by which hospitals can optimize antibiotic utilization
  4. Review the latest recommendations for preventing antibiotic resistance among hospitalized patients
Authors and Disclosures

Marin H. Kollef, MD
Disclosure: Marin H. Kollef, MD, has disclosed that he has served as an advisor or consultant to Merck, Pfizer, and Wyeth, and that he has served on the speaker's bureau for C. R. Bard, Inc.


David L. Paterson, MD, PhD
Disclosure: David L. Paterson, MD, PhD, has disclosed that he has received grants for clinical research from AstraZeneca, Merck, and Pfizer. Dr. Paterson has also disclosed that he has served as an advisor or consultant to AstraZeneca, Merck, Cubist, and Wyeth, and as a speaker for Merck, Roche, and Pfizer.


Michelle Manzo, MPH
Disclosure: Michelle Manzo, MPH, has disclosed no relevant financial relationships.
 
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Medscape, LLC designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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This Activity is sponsored by Medscape Continuing Education Provider Unit.

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Awarded 1.0 contact hour(s) of continuing nursing education for RNs and APNs; 1.0 contact hours are in the area of pharmacology.

Provider Number: 6FDKKC-PRV-05

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