Infection Prevention, Antimicrobial Stewardship, and Sepsis — WACS Viva & Clinical Scenarios (Infectious and Tropical Diseases)

Exam-style infection prevention, antimicrobial stewardship, and sepsis viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 58-year-old male with poorly controlled diabetes mellitus is admitted from the emergency department with altered consciousness, tachypnoea (respiratory rate 32 breaths per minute), blood pressure 82/45 mmHg, heart rate 128 beats per minute, temperature 39.1°C, and random blood glucose 18.2 mmol/L. Outline your step-by-step diagnostic and resuscitation plan within the first hour of presentation according to international and regional sepsis guidelines.
• SCENARIO 2: A 65-year-old patient admitted to the medical intensive care unit with a central venous catheter develops high-grade fever and rigors on day 6 of admission. Detail the diagnostic criteria to confirm a Central Line-Associated Bloodstream Infection (CLABSI), the immediate bedside interventions required, and the evidence-based insertion and maintenance bundles used to prevent this complication.
• SCENARIO 3: A urine culture from an inpatient with pyelonephritis yields Klebsiella pneumoniae resistant to third-generation cephalosporins, piperacillin-tazobactam, and meropenem, but susceptible to colistin and ceftazidime-avibactam. Discuss the biochemical and molecular resistance mechanisms responsible for this phenotype and structure an appropriate therapeutic regimen incorporating pharmacokinetic and pharmacodynamic optimization.
• SCENARIO 4: You are appointed to lead the Antimicrobial Stewardship Committee in a 400-bed regional referral hospital. Describe the core components of the hospital AMS program, how you would apply the World Health Organization (WHO) AWaRe framework to the institutional drug formulary, and your metrics for auditing antibiotic usage.
• SCENARIO 5: A house officer experiences a deep needlestick injury with a hollow-bore needle while drawing blood from an inpatient whose HIV, Hepatitis B, and Hepatitis C status are unknown. Detail the immediate wound care, baseline diagnostic evaluations, risk assessment, and specific post-exposure prophylaxis (PEP) protocols for each blood-borne virus.