An 81-Year-Old Man Is Transferred from a Skilled Nursing Facility

question 55

Multiple Choice

An 81-year-old man is transferred from a skilled nursing facility to the hospital due to lethargy and poor oral intake over the last 24 hours.  For the past 2 days, he has had increased urinary frequency and dysuria.  A urinalysis showed evidence of urinary tract infection, and he was started on oral ciprofloxacin.  He was recently hospitalized with acute ischemic stroke, and his hospital course was complicated by pneumonia requiring intravenous antibiotics.  He also had an episode of urinary retention requiring Foley catheter placement for 5 days.  His other medical problems include mild cognitive impairment, hypertension, and type 2 diabetes mellitus.  He has no known drug allergies.
His temperature is 38.9° C (102° F) , blood pressure is 92/58 mm Hg, and pulse is 112/min.  Lungs are clear to auscultation.  His extremities are warm and well perfused.
Foley catheter placement yields 230 mL of cloudy urine.
Laboratory results are as follows:

Urine culture obtained at the nursing facility 2 days earlier showed extended spectrum beta-lactamase-producing Klebsiella.
Which of the following is the best initial antibiotic regimen for this patient?

• A)Aztreonam
• B)Ceftriaxone
• C)Daptomycin
• D)Levofloxacin
• E)Meropenem

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Definitions:

Homeopathy

A system of alternative medicine based on the principle that like cures like, where diseases are treated with minute doses of natural substances that in larger amounts would produce symptoms of the disease.

Herbalism

The practice of using herbs and plants for medicinal or therapeutic purposes, often part of traditional or alternative medicine systems.

Goal Attainment

The process of setting, pursuing, and achieving goals.

Treating Physician

A healthcare professional responsible for diagnosing and managing the care of a patient's health condition.