Candida auris Prevention and Management: A Case-based Course:  Posttest

To obtain your certificate from MSGERC for completing this, you will need to successfully complete this posttest and fill out the evaluation. A score of 70 or greater is required on the posttest. 

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A 61-year-old woman with diabetes mellitus presented to the hospital with worsening pain, redness, and drainage from an ulcer on her right foot. The patient previously received multiple courses of antibiotic therapy for diabetic foot infections and resides at a long-term acute-care hospital (LTACH). After admission, podiatry took the patient to the operating room for debridement and partial right calcanectomy. Operative cultures returned positive for methicillin-resistant Staphylococcus aureus and yeast, which is then identified as Candida auris. This is the first known case of Candida auris at your hospital. What isolation precautions are recommended for the patient?
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10 points
What is an additional strategy to prevent transmission in your healthcare facility?
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10 points
A 42-year-old man with methicillin-resistant S aureus osteomyelitis residing at a long-term acute-care hospital presents to the hospital febrile. A peripherally inserted central catheter is removed. On day 3, blood cultures return positive for C auris. The catheter tip also returns positive for C auris. The patient is immediately placed on contact precautions and is currently on day 5 of micafungin 100 mg daily for therapy. How long should the patient remain on contact precautions?
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10 points
Environmental services personnel inquire about disinfection procedures and protocols for the patient’s room. What are the recommended agents for disinfection?
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10 points
A 74-year-old man with heart disease is transferred to your LTACH from the acute-care hospital after undergoing an aortic valve replacement. After a prolonged hospitalization involving hospital-acquired pneumonia, he has a tracheostomy, a gastric feeding tube, and an indwelling Foley catheter. He has just completed a second course of broad-spectrum antibiotics via a peripherally inserted catheter (PICC) line. The acute-care facility is known to have had several patients with Candida auris colonization and infection. The patient’s blood, urine, and sputum cultures were all negative at the time the patient was transferred. The patient is currently stable and doing well. On the admission physical exam, his vital signs are all stable, and he is afebrile. What should be done when the patient is transferred to your LTACH facility?
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10 points
Whom do you not need to inform if the patient screens positive for C auris colonization?
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10 points
You have a patient with surgical complications and a PICC line as well as a history of a multidrug-resistant bacterial infection. He is now feverish with abdominal pain and diarrhea. If your laboratory identifies yeast in a blood culture sample as possible C haemulonii, what should you do? 
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10 points

Which of the following is true about C auris management?

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10 points
You have a patient with a C auris infection who is being treated with an echinocandin. Susceptibility testing shows fluconazole resistance and an elevated minimum inhibitory concentration for the echinocandin. Which of the following is a reasonable next step?
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10 points
You are treating a patient with a C auris infection with an echinocandin. He became afebrile and was feeling better on day 10 of treatment. The day 14 blood culture is negative. How long should you continue treatment?
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10 points
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