A 56 year old patient  who has been on meropenem  and  fluconazole  for six days for intra-abdominal sepsis has developed new fevers and grown a Gram negative organism in the blood. The sensitivities are given below:

Gentamicin

Tobramycin

Ampicillin

Imipenem

Ciprofloxacin

Ticarcillin

Gram negative
rods

R

R

R

R

R

R

List  three  likely  causative   organisms  of  the  new  sepsis.  What   is  an  appropriate antibiotic for each of the listed organisms?

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College Answer

1. Stenotrophomonas maltophilia - Bactrim
2. Multi-resistant Acinetobacter – Amikacin/colistin
3. Multi-resistant pseudomonas / Burkholderia - Amikacin
4. Enterobacter/proteus – Amikacin

Discussion

This question is identical to Question 23.3 from the first paper of 2013.