Clinical microbiology and hospital infection control: antibiotic de-escalation: practice question

A Microbiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Microbiology · Clinical microbiology and hospital infection control: antibiotic de-escalation

Sample item

A septic patient is started on piperacillin-tazobactam plus vancomycin. At 72 hours, blood cultures grow only a fully susceptible Escherichia coli, and the patient is improving. Which stewardship action is appropriate?

AAdd a carbapenem for additional coverBContinue both drugs for 14 daysCDe-escalate to a narrower agent guided by susceptibilityDStop all antibiotics immediately

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. De-escalate to a narrower agent guided by susceptibility

Antimicrobial stewardship includes reviewing therapy at 48 to 72 hours and narrowing when culture data are available. Vancomycin has no role against a Gram-negative isolate, and a narrower active agent lowers resistance pressure and toxicity.

Option by option

A. Add a carbapenem for additional cover
Adding a carbapenem escalates unnecessarily against a susceptible isolate.
B. Continue both drugs for 14 days
Continuing broad dual therapy adds toxicity and resistance pressure without benefit.
C. De-escalate to a narrower agent guided by susceptibility (correct)
Correct. Narrow therapy to an active, narrow-spectrum agent once the organism is known.
D. Stop all antibiotics immediately
Stopping all treatment in a patient with bacteraemia risks relapse.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Microbiology question

What is the answer to this Microbiology question?

The best answer is C, De-escalate to a narrower agent guided by susceptibility. Antimicrobial stewardship includes reviewing therapy at 48 to 72 hours and narrowing when culture data are available.

Why is "Add a carbapenem for additional cover" not the answer?

Adding a carbapenem escalates unnecessarily against a susceptible isolate.

Why is "Continue both drugs for 14 days" not the answer?

Continuing broad dual therapy adds toxicity and resistance pressure without benefit.

Why is "Stop all antibiotics immediately" not the answer?

Stopping all treatment in a patient with bacteraemia risks relapse.

What concept does this question test?

It tests Clinical microbiology and hospital infection control: antibiotic de-escalation in Microbiology. Vancomycin has no role against a Gram-negative isolate, and a narrower active agent lowers resistance pressure and toxicity.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Clinical microbiology and hospital infection control: antibiotic de-escalation?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.