Five moments for hand hygiene

• All of the following are moments of hand

hygiene, EXCEPT:
1. Before touching a patient
2. After touching a patient
3. Before a procedure
4. After a procedure
5. Before touching a patient’s surroundings
6. After touching a patient’s surroundings
Steps of hand hygiene.
• One step is extra .
• Not recommended by
WHO.
• Please point out , the
step which is not
recommended in the
WHO hand hygiene
steps.
 QUESTION-
What is the resistant mechanism?
What will be your choice of antibiotic?

KLEBSIELLA
PNEUMONIAE
• A55 year female.
• Total WBC 22,000.
AMPICILLIN R
• Fever, chills.
CEFTRIAXONE R
• Patient is on Meropenem.

MEROPENEM R

OXA48 POSITIVE

COLISTIN R
 QUESTION-

What will be your choice of antibiotic?

KLEBSIELLA • A55 year female,

PNEUMONIAE
• Foleys catheterized.
• Many pus cells in urine R/E.
AMPICILLIN R
• Urine-Significant bacteriuria .
CEFTRIAXONE R
• Total WBC 8,000.
MEROPENEM R
• No Fever, No chills.
• Patient is on Meropenem.
OXA48 POSITIVE

COLISTIN R
 QUESTION-
Staphylococcus aureus from blood culture. What
will be your choice of antibiotic?

Staphylococcus
aureus
• Patient is on Ceftriaxone.
PENICILLIN R

CEFOXITIN SCREEN S (NEGATIVE)

VANCOMYCIN S

LINEZOLID S

TIGECYCLINE S
 QUESTION-
Staphylococcus aureus from blood culture. What
will be your choice of antibiotic?

Staphylococcus
aureus
• Patient is on Ceftriaxone.
PENICILLIN R

CEFOXITIN SCREEN R (POSITIVE)

VANCOMYCIN S
MIC-1.5 BORDERLINE

LINEZOLID S

TIGECYCLINE S
 QUESTION-
What is the resistant mechanism?
What will be the correct choice of antibiotic?

KLEBSIELLA
PNEUMONIAE
• A55 year female, urine
culture -klebsiella. Blood
AMPICILLIN R culture negative.
CEFTRIAXONE R • Total WBC 22,000.
• Patient is on Meropenem.
MEROPENEM S And improved.

CEFOXITIN S

CIPROFLOXACIN R
 QUESTION-
What will be the correct choice of antibiotic?

Enterobacter
cloacae
• A55 year female, urine
culture -Enterobacter.
AMPICILLIN R • Blood culture negative.
CEFTRIAXONE S • Total WBC 22,000.
• Patient is on Ceftriaxone.
MEROPENEM S

CEFOXITIN R (Inducible Amp-C)

CIPROFLOXACIN S
• Stenotrophomonas maltophila isolated from a
patient with Ventilator associated pneumonia
from lung.
• Patient is on Colistin and Meropenem.
• Susceptibility report is pending.
• Please suggest an appropriate antibiotic.
• An immunocompetent hemiplegic patient on
ventilator, grew candida tropicalis from
sputum.
• Suggest an appropriate antifungal agent here.
• A cellulitis patient , grew streptococcus
pyogenes in blood, which is resistant to
penicillin.
• What is wrong in this susceptibility?
• An oral cavity carcinoma patient is on
piperacillin tazobactam and metronidazole for
the anaerobic and aerobic bacteria which was
cultured from the drained pus.
• You wanted to stop one antibiotic. Which one
of these, can be stopped without any issue in
the antimicrobial activity.
• Purpura fulminans, is
described most
commonly with
Meningococcemia,
Please name some
other infectious
conditions, which may
leads to this.
 2. Isolate from CSF
• 78-year-old feamle
• Signs and symptoms of meningitis
• Patient on ceftriaxone: NO IMPOVEMENT.
• Lab reported gram positive bacilli.

• What would you want to change the antibiotic

to?
Thank you