MRSA的診斷、治療與醫院感染管制 解答

Staphylococcus Aureus(SA)的菌血症，在下列何種情形，最易有合併症(complicated Staphylococcus aureus bacteremia)發生?

• 1.Community-acquired infection
• 2.A positive result of follow-up blood culture at 48-96 hours
• 3.Persistent fever at 72 hours
• 4.skin findings suggestive of acute systemic infection

關于fluoroquinolone與MRSA的關係，下列何者有誤?

• 1.Should not be used to treat invasive MRSA infection
• 2.Fluoroquinolone是MRSA皮膚軟組織感染的首選用藥
• 3.Fluoroquinolone的使用，會使病人帶有MRSA的機會增加
• 4.Fluoroquinolone的使用，會易selective出MRSA及其他Fluroquinolone抗藥性菌

關于MRSA的transmission方式，下列何者有誤?

• 1.inhalation of aerosolized droplets from chronic nasal carriers
• 2.Contact with Contaminated inanimated objects
• 3.contact with another individuals colonized intact skin
• 4.以上皆錯

下列那些patients較適合來執行MRSA的activesurveillance screening?

• 1.History of MRSA colonization
• 2.In intensive care
• 3.Extensive contact with health care system
• 4.以上皆是

關于MRSA在public health的重要性，下列何者正確？

• 1.Increased morbidity and mortality
• 2.prolong hospital stay
• 3.Extra hospital costs
• 4.以上皆是

金黃色葡萄球菌容易造成下列何種感染?

• 1.皮膚、軟組織
• 2.骨及關節
• 3.人工管路
• 4.以上皆是

關于MRSA decolonization，下列何者有誤?

• 1.Whole-body Chlorhexidine washing only can not eradicate MRSA colonization
• 2.MRSA nasal colonization appears to precede infection
• 3.No emergence of resistance to agents used for decolonization
• 4.mupirocin is drug of choice for eradication of nasal colonization

台灣醫院醫學中心及區域醫院ICU MRSA百分比大約在

• 1.60-80%
• 2.40-60%
• 3.20-40%
• 4.0-20%

社區型的MRSA( CA-MRSA)與院內感染之MRSA ( HA-MRSA)，相異處何者有誤?

• 1.CA-MRSA常發生在免疫受損者
• 2.HA-MRSA抗藥性程度比CA-MRSA約為高
• 3.CA-MRSA較發生在皮膚軟組織
• 4.HA-MRSA的發生率常與管路有關

關于MRSA的敘述，何者有誤?

• 1.其抗生素抗藥性主 要是因帶有mec A gene
• 2.對B-lactam抗生素有high affinity
• 3.除了Methicillin，Oxacilin無效外，對cephalosporin也有抗藥性
• 4.使用非B-lactam類抗生素，可能有效

關于Vancomycin的使用，下列何種有誤?

• 1.Inferior to B-lactam for treatment of MRSA bacteremia and endocarditis
• 2.For the treatment of infection due to MRSA isolates with vancomycin MIC>0.5, optimized pk/pd targets may not be achievable
• 3.antibiotic of choose of MRSA infection
• 4.There are MRSA MIC creep in some regions of the world

關于 MRSA的敘述，何者有誤?

• 1.Antibiotic use ( particularly cephalosporin & fluroquinolone use) correlates with the risk for MRSA colonization and infection
• 2.The incidence of invasive MRSA infection was 10 times higher among dialysis patients than in general population
• 3.The risk of MRSA infection among MRSA colonization patients in ICUs around 10-25%
• 4.MRSA- Colonized residents are frequently transferred between hospitals and long-term care facilities

關于MRSA的active surveillance cultures，可選擇下列哪個部位?

• 1.Anterior nares
• 2.Rectum
• 3.Areas of skin breakdown
• 4.以上皆是

治療CA-MRSA(社區型MRSA)的建議用藥何者不是?

• 1.Clindamycin
• 2.trimethoprim-sulfamethoxazole
• 3.Tetracycline
• 4.Levofloxacin

About Pathogenesis of SA infection，何者有誤?

• 1.Main ecological niche is anterior nares
• 2.Most S. aureus disease caused by the patient `s own bacteria
• 3.colonization increased risk of subsequent infection
• 4.以上皆錯