Predicting and Defining Vancomycin Efficacy: Posttest and Program Evaluation

Clinical Infectious Diseases, Jan 2006

Robert C. Moellering Jr., Patrice Courvalin, Ronald N. Jones, Donald P. Levine, Michael J. Rybak, Dennis L. Stevens, George Sakoulas

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Predicting and Defining Vancomycin Efficacy: Posttest and Program Evaluation

CID Predicting and Defining Vancomycin Efficacy: Posttest and Program Evaluation Robert C. Moellering Patrice Courvalin Ronald N. Jones Donald P. Levine Michael J. Rybak Dennis L. Stevens George Sakoulas 4. Although precise and aggressive pharmacokinetic adjustments via repeated measuring of serum concentrations may not be necessary, monitoring of serum drug levels is often warranted for patients treated with vancomycin… a. who have reduced renal function. b. by use of a validated nomogram that maintains trough serum concentrations at 4-5 times the minimum inhibitory concentration (MIC). c. in combination with another antibiotic agent. d. who have infections in tissues where drug penetration is poor. - POSTTEST 1. van resistance genes originating from enterococci species have been transferred to Staphylococcus aureus to create highly vancomycin-resistant strains (VRSA). This has been determined experimentally through a. analysis of clinical isolates from patients in Michigan (strain MI-VRSA), Pennsylvania (strain PA-VRSA), and New York (strain NY-VRSA). b. large clinical trials. c. the use of statistics. d. none of the above, because interstrain bacterial conju gation does not occur. 2. The type of glycopeptide resistance most commonly found in enterococci species is VanA. A distinguishing characteristic of VanA-type resistance is that a. the VanA gene cluster encodes unique proteins without homology to other van genes. b. it rarely is a clinical problem. c. to date, it is the only type of glycopeptide resistance found in clinical S. aureus isolates. d. all of the above. 3. During the 1980s, many bacterial strains exhibited reduced susceptibility to vancomycin as a result of more widespread use of vancomycin. Resistance and reduced susceptibility to vancomycin have been attributed to what treatment trend(s): a. intracolonic administration of vancomycin. b. widespread use of vancomycin to treat Clostridium difficile infections. c. empirical vancomycin treatment for community-acquired pneumonia. d. widespread use of vancomycin to treat pseudo membranous enterocolitis and the increase in the prevalence of resistant pathogens, such as methicillinresistant S. aureus (MRSA). 8. Vancomycin has been used for many years to resolve infections, including those caused by MRSA. When administering the drug to patients, clinicians should a. watch for nephrotoxicity, especially in pediatric subjects. b. establish a definitive diagnosis, obtain antibiotic susceptibility information, be aware of resistance patterns of community- and hospital-acquired pathogens, and monitor serum drug levels. c. avoid all treatment combinations with aminoglycosides. d. all of the above. ANSWER SHEET AND INSTRUCTIONS Please indicate your answers to the CME posttest by circling one answer for each question. 1. 2. 3. 4. 5. 6. 7. 8. 9. A A A A A A A A A B B B B B B B B B C C C C C C C C C D D D D D D D D D PROGRAM EVALUATION CONTACT INFORMATION (please print clearly): 9. Which laboratory findings indicate that therapeutic alternatives to vancomycin should be considered for patients’ therapy? a. Reference minimum bactericidal concentration (MBC) testing results suggest a lack of bactericidal action. b. Vancomycin MIC 10.5 mg/mL. c. Vancomycin MIC 12.0 mg/mL. d. Vancomycin MIC 14.0 mg/mL. There is no fee to complete this test. Completed tests may be mailed or faxed to Boston University School of Medicine. Mailing instructions. After filling out the answer sheet, please mail this form and the Program Evaluation to Predicting and Defining Vancomycin Efficacy, CME Program: Course code E.IDFUSION05, Continuing Medical Education, Boston University School of Medicine, 715 Albany Street, A305, Boston, MA 02118. Faxing instructions. After filling out the answer sheet, please fax this form and the Program Evaluation to Predicting and Defining Vancomycin Efficacy, CME Program: Course code E.IDFUSION05, Continuing Medical Education, Boston University School of Medicine (fax: 617-638-4905). If you have any questions, please call 617-638-4605. The amount of time that it took you to complete and review the journal supplement and complete this test was ___ hours (maximum 3 hours). Please take a few minutes to answer these questions regarding the journal supplement after you have completed the course and, if applicable, the test. Your responses will help us improve the content and presentation of future journal supplements. 1. In general, what is your opinion of the “Predicting and Defining Vancomycin Efficacy” program? 5. What were the weak points of the “Predicting and Defining Vancomycin Efficacy” program journal supplement? 2. How well were the educational objectives met? Exceptionally Very Well Well Poorly 3. Please rate the following aspects of the activity: Excellent Good Fair Poor Feature Articles Vancomycin: A History Microbiological Features of Vancomycin in the 21st Century… Vancomycin Resistance in Gram-Positive Cocc (...truncated)


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Robert C. Moellering Jr., Patrice Courvalin, Ronald N. Jones, Donald P. Levine, Michael J. Rybak, Dennis L. Stevens, George Sakoulas. Predicting and Defining Vancomycin Efficacy: Posttest and Program Evaluation, Clinical Infectious Diseases, 2006, pp. S58-S61, 42/Supplement 1, DOI: 10.1086/491716