A patient who had been on meropenem and fluconazole for 6 days for intra- abdominal sepsis developed new fevers and grew a Gram negative organism in the blood. The initial sensitivities are given below. Further sensitivity testing will take another 24 hours.

Gentamicin

Tobramycin

Ampicillin

Imipenem

Ciprofloxacin

Ticarcillin

Gram negative

rods

R

R

R

R

R

R

List 3 likely causative  organisms of the new sepsis. What is an appropriate antibiotic for each of the listed organisms, whilst waiting for the final sensitivity report?

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College Answer

Stenotrophomonas maltophilia  - Bactrim

Multi-resistant Acinetobacter – Amikacin/colistin

Multi-resistant pseudomonas / Burkholderia - Amikacin

Enterobacter/proteus - Amikacin

Discussion

This question is identical to Question 23.3 from the first paper of 2013, and to Question 25.3 from the second paper of 2009.