Infectious Disease and Antimicrobial Stewardship
Balance prompt, appropriate empiric therapy with stewardship. Know the common hospital-acquired syndromes: community-acquired pneumonia (CAP), hospital-acquired and ventilator-associated pneumonia (HAP/VAP), catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and Clostridioides difficile infection. Understand when to start broad and when to de-escalate based on cultures, and the importance of source control (drainage, line removal). Recognize sepsis bundles and the role of MRSA and Pseudomonas coverage based on risk factors.
Traps
Questions test the difference between colonization and infection - asymptomatic bacteriuria should not be treated except in pregnancy or before urologic procedures. Do not treat a positive urine culture in a patient without urinary symptoms. Know that C. difficile requires stopping unnecessary antibiotics, contact precautions, and oral vancomycin or fidaxomicin for severe disease; do not use oral metronidazole for severe cases. Watch for drug-bug mismatches (e.g., empiric coverage that misses anaerobes in aspiration or misses Pseudomonas in a neutropenic patient).
Rule of thumb
Before starting antibiotics, ask three questions: Is this infection or colonization? What is the likely source and organism? What is the shortest effective course? Reassess at 48-72 hours and de-escalate.