American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the treatment regimen for hospital-acquired bacterial meningitis?

1. IV moxifloxacin alone

2. IV vancomycin plus either IV ceftazidime, cefepime, or meropenem

3. IV ampicillin and IV cefotaxime

4. IV piperacillin-tazobactam

The correct answer is: IV vancomycin plus either IV ceftazidime, cefepime, or meropenem

The recommended treatment regimen for hospital-acquired bacterial meningitis is indeed the combination of intravenous vancomycin with either intravenous ceftazidime, cefepime, or meropenem. This approach is effective due to the specific pathogens commonly associated with this type of meningitis, particularly resistant strains of bacteria. Vancomycin is crucial because it targets methicillin-resistant Staphylococcus aureus (MRSA), which can be a common causative organism in hospital-acquired infections. The addition of a broad-spectrum cephalosporin (such as ceftazidime or cefepime) or a carbapenem like meropenem further helps to cover for other potential gram-negative pathogens, including Pseudomonas aeruginosa, which are also frequent in hospital settings. This combination thus provides a broad coverage against a wide range of possible bacteria, taking into consideration antibiotic resistance patterns often present in hospital environments. Additionally, the rationale behind not choosing only one antibiotic from the other options lies in the need for a comprehensive treatment strategy that ensures adequate coverage until the specific pathogen is identified and sensitivities determined. Hospital-acquired bacterial meningitis presents with unique challenges due to the variety of pathogens that can cause it, necessitating a more aggressive