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Volume 19, Number 8—August 2013

CME ACTIVITY - Research

Extended-Spectrum β-Lactamase–producing Enterobacteriaceae among Travelers from the Netherlands

Earning CME Credit

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions (with a minimum 70% passing score) and earn continuing medical education (CME) credit, please go to www.medscape.org/journal/eid. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers. You must be a registered user on Medscape.org. If you are not registered on Medscape.org, please click on the New Users: Free Registration link on the left hand side of the website to register. Only one answer is correct for each question. Once you successfully answer all post-test questions you will be able to view and/or print your certificate. For questions regarding the content of this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@webmd.net. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please refer to http://www.ama-assn.org/ama/pub/category/2922.html. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit may be acceptable as evidence of participation in CME activities. If you are not licensed in the US, please complete the questions online, print the certificate and present it to your national medical association for review.

Article Title:
Extended-Spectrum β-Lactamase–producing Enterobacteriaceae among Travelers from the Netherlands

CME Questions

1. You are seeing a 50-year-old woman for a routine physical exam before she embarks on a 3-month trip around the world. She is concerned regarding the possibility of illness during her travels. Based on the current study by Paltansing and colleagues, what should you consider regarding acquisition of multidrug-resistant Enterobacteriaceae (MDR-E) during travel?

A. Incident colonization occurred in approximately 80% of travelers

B. Incident colonization occurred in approximately 30% of travelers

C. MDR-E was not found among any individual prior to travel

D. Over 90% of MDR-E found after travel was carbapenemase-producing Enterobacteriaceae (CPE)

2. What can you tell this patient was the region most associated with colonization with MDR-E in the current study?

A. Eastern Europe

B. Sub-Saharan Africa

C. Asia

D. Central America

3. Which of the following was the most significant risk factor for colonization with MDR-E after returning from travel?

A. Colonization with MDR-E prior to travel

B. Older age

C. Recent antibiotic use

D. A history of diarrhea during travel

4. What else should you consider regarding the acquisition of extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-E) during travel in the current study?

A. CTX-M enzymes were the predominant ESBLs

B. Coresistance to other antibiotics was rare among ESBL-E

C. ESBL-E was not found among any carrier after 6 months of follow-up

D. ESBL-E was not found among household contacts of carriers

Activity Evaluation

1. The activity supported the learning objectives.

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2. The material was organized clearly for learning to occur.

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3. The content learned from this activity will impact my practice.

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4. The activity was presented objectively and free of commercial bias.

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