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.
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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.
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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?
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Poorly
3. Please rate the following aspects of the activity:
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