Antimicrobial Stewardship and Resistance — Clinical Case

DCE Long Case

Patient brief

Patient: A hospitalised adult with suspected infection and multiple antibiotic exposures. ^[1]

Presenting complaint: Fever and focal infective symptoms after recent broad-spectrum therapy. ^[1]

Past history: Multimorbidity including prior hospitalisations and possible resistant organism risk factors. ^[2]

Medications: Current and recent antimicrobials, allergies, and interacting drugs. ^[1]

Examination: Source-focused findings and severity markers. ^[1]

Investigations: Cultures, inflammatory markers, imaging as indicated, and susceptibility data when available. ^[2]

Tasks

1. Present a stewardship-focused problem list. ^[1]
2. Choose empiric then targeted therapy with de-escalation criteria. ^[1]
3. Define IV-to-oral switch, duration, and resistance-prevention actions. ^[2]

Model discussion points

• Right drug, dose, route, duration. ^[1]
• Cultures before antibiotics when safe. ^[2]
• De-escalation and stop dates. ^[1]
• Infection prevention and allergy verification. ^[2]