A 30-Year-Old Man Comes to the Emergency Department Due to a Week

question 409

Multiple Choice

A 30-year-old man comes to the emergency department due to a week of fever, chills, and generalized malaise.  The patient uses intravenous heroin and has been hospitalized several times due to skin and soft tissue infections.  Cardiac auscultation shows a systolic ejection murmur, and subsequent echocardiography reveals a vegetative lesion of the aortic valve.  Blood cultures from admission grow Enterococcus faecalis; subsequent testing reveals D-lactate rather than D-alanine as the terminal amino acid in the bacteria's pentapeptide peptidoglycan cell wall precursor.  This substitution is likely to significantly decrease the efficacy of which of the following antibiotics?

• A)Ceftriaxone
• B)Fosfomycin
• C)Penicillin
• D)Polymyxin
• E)Tetracycline
• F)Vancomycin

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Definitions:

Formal Orientation

An organized introduction and training program for new employees to familiarize them with the company policies, procedures, and culture.

Cost-effective Manner

An approach or method that achieves the desired outcome without unnecessary expenditure, ensuring the best possible use of resources.

Procedures

Set methods or steps followed to complete certain tasks or operations within an organization or process.

On-the-job Training

Hands-on training provided to employees while they perform their regular work tasks.