USMLE:- Enterococcus faecalis sepsis (VERSA) infection: Step 2 ck USMLE ID qbank question

[saudi-dr]

Enterococcus faecalis sepsis (VERSA) infection: Step 2 ck USMLE ID qbank question

A 67-year-old woman is admitted to the intensive care unit following urgent surgery because of bowel perforation and peritonitis. Despite having a colostomy and careful peritoneal lavage, she remains hypotensive and intubated postoperatively. She improves somewhat after ceftazidime and metronidazole are started by intravenous infusion, but on hospital day 9 she develops a new fever and recurrent hypotension. All intravenous catheters are replaced, blood cultures are obtained, and vancomycin is added to her regimen.
On hospital day 11, a blood culture and a catheter tip culture are both growing an Enterococcus faecalis strain that is resistant to vancomycin but susceptible to ampicillin. Repeat blood cultures are obtained, and intravenous ampicillin is substituted for vancomycin.
Three days after ampicillin is started, her fever persists, and she has developed an extensive rash. The blood cultures obtained on days 9 and 11 are all growing the same strain of E. faecalis.

Which of the following should be done next?

A. No change in antibiotics is needed, as the infected intravenous catheter was removed
B. Begin piperacillin/tazobactam; stop all other antibiotics
C. Begin quinupristin/dalfopristin; stop ampicillin
D. Begin linezolid; stop ampicillin
E. Stop ampicillin; resume this drug after the patient completes a desensitization protocol




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Members may check the correct answer file posted below

[sthav]

Begin quinupristin/dalfopristin; stop ampicillin

[MOHDASHRAF]

CORRECY ANSWER A

[Dr Issa]

eeeeeeeeeeeee

[hawa333]

answer is C