196.

A researcher analyzing the emergence of antibiotic resistance in outpatient urinary Escherichia coli
isolates treated an agar plate containing several growing colonies of the isolated bacteria with
levofloxacin. Following treatment, bacterial growth continued in a single colony. Which of the following
mechanisms most likely conferred resistance in the bacteria displaying continued growth?

A. Production of beta-lactamase
B. Modification of surface binding proteins
C. Inactivation by bacterial transferase
D. Replacement of D-alanine
E. Mutation of DNA gyrase

197. A homeless 40-year-old man with a history of splenectomy, presents to the emergency department
(ED) with fever. His splenectomy was performed when he was 30 years old following trauma. He had
received appropriate vaccinations immediately after his trauma but has not had any medical care for the
last 10 years. He is noted to have a fever of 102°F (39°C), blood pressure (BP) of 71/40 mmHg, heart rate
(HR) of 127 bpm, respiratory rate (RR) of 29 breaths/min, and oxygen saturation (SaO2) of 95% on room
air. Despite antibiotic therapy, he develops multisystem organ failure from sepsis and dies. Which
bacteria is most likely cause of this presentation?
A. Staphylococcus aureus
B. C. diphtheriae
C. Pneumococcus
D. E. coli
E. H. pylori

198. A 4-year-old Caucasian child is brought to the doctor’s office by his parents for an evaluation of
loose greasy stools for past few months. The child has been frequently seen by other physicians for
episodes of productive cough and rhinorrhea, in the past. The parents state that he has been coughing
up purulent mucus for 4 days and deny fever or chills. He has had pneumonia 4 times since birth.
Delivery of the child and neonatal course were uncomplicated. He was breast-fed until the age of 4
months. There is a history of cystic fibrosis in the family of both of his parents.

Vitals: Pulse: 98/min, B.P: 80/50 mm Hg, Temp: 102 F/ 38.9 C, Respiration rate: 20/min.

Physical exam reveals nasal polyps, regular heart rate and rhythm, lungs with bilateral wheezes,
increased AP diameter, and intercostal retractions, with abdomen that non-distended, non-tender and
normoactive bowel sounds.

Vaccinations: Up-to-date.

Which of the following organisms is unlikely to be found in the sputum of a patient with cystic fibrosis?

A. Haemophilus influenzae
 B. Acinetobacter baumannii

C. Burkholderia cepacia

D. Aspergillus fumigatus

E. Staphylococcus aureus

199. A 70-year-old man presents to the hospital with a week of fever, chills, nausea, and right upper
quadrant pain (RUQ). He describes the pain to be non-radiating, 7/10 intensity, exacerbated with
breathing, and relieved minimally with Tylenol. The symptoms started suddenly, however, he has had
several episodes of same RUQ pain in the past. He explains that he was admitted few years ago for
cholelithiasis but had declined an elective cholecystectomy. He does not take any medications. He lives
with his wife and performs his daily activities independently. He does not smoke, drink or do illicit drugs.
His temperature is 102 F (39 C), and he appears toxic. His BP is 115/71 mmHg, HR is 115 bpm, and RR is
24 breaths/min with room air SaO2 of 91%. He has diminished breath sounds at the right lung base and
diffuse tenderness in the right upper quadrant. His CT scan of the abdomen shows a large, complex,
multiloculated liver abscess in the right lobe. Which of the following statements regarding his condition
or therapy is true?

A. Antibiotic therapy targeting Staphylococcus aureus, should be started.

B. Antibiotic therapy targeting E.coli should be started.
C. Antibiotic therapy targeting Candida albicans, should be started.
D. Antibiotic therapy targeting Actinomyces should be started.
E. Antibiotic therapy against Enterococcus. sp should be started.

200. A 25-year-old woman presents with 2 days of urinary frequency, urgency, and pelvic discomfort
and vaginal discharge. The discharge is clear and is odorless. She has no pain in her vulva on urination.
She has no other medical problems and does not have fever. She is sexually active with 3 partners within
last year. Her vitas are within normal limits. Her physical exam reveals no skin rash, and the vaginal
exam is without erythema, but there is visible clear cervical discharge that is odorless. A microscopic
examination of her urine shows pyuria but no pathogens. After 24 hours, her urine culture does not
grow any pathogens. Which of the following organisms is most likely to be the cause of her symptoms?
A. Neisseria gonorrhea
B. Chlamydia trachomatis
C. E. coli
D. Staphylococcus aureus
E. Candida albicans

201. A 40-year-old woman has been hospitalized for 30 days following a stabbing with penetrating chest
and abdominal trauma. She had a right-sided hemopneumothorax as well as large bowel injury requiring
hemicolectomy and hepatic contusion. She presented in hemodynamic shock and subsequently
developed multiorgan failure due to septic shock. She remains critically ill on mechanical ventilation via
a tracheostomy tube and on hemodialysis. She had been off vasopressors for 1 week but acutely
became febrile over night with a drop in her BP to 72/38 mmHg and HR of 148 bpm. The patient has
new infiltrates on chest radiograph and increased thick yellow secretions from her tracheostomy tube.
Recently, the surgical intensive care unit has had multiple cases of K. pneumoniae that produce an
extended-spectrum β-lactamase (ESBL). Which of the following statements regarding the ESBL bacteria
is true?

A. An ESBL-producing organism is unlikely to be the cause of the patient’s recurrent sepsis because
bacteria that produce ESBL rarely cause ventilator-associated pneumonia.
B. An ESBL-producing organism is unlikely to cause the patient’s recurrent sepsis because the
resistance mechanism does not promote easy transmission of organisms among patients within
the intensive care unit.
C. The resistance mechanism in ESBL-producing bacteria is related to a genetic mutation that
passes down generations.
D. The resistance mechanism in ESBL-producing organisms is plasmid-mediated and is easily passed
among bacteria.
E. There is no existing mechanism proposed for ESBL resistance transmission.

202. A 70-year-old male is admitted to the hospital for a fever and cough for 2 days. The patient lives at
nursing home, when the staff found him to be less active and confused. The patient was noted to have a
fever of 102 F (39 C), and tachypneic. He has no other medical history. He does not drink alcohol, smoke
or do illicit drugs. His vitals are 101.8 F (38.8 C), 90/60 mmHg, 110 bpm, and RR of 30/min. He is alert
and oriented to place and person only, lungs exam reveals dullness to percussion to right lower area, but
no wheezing or crackles. His heart exam is tachycardic with regular rhythm and no murmurs. A blood
culture is ordered and the intern taking care of the patient visits the microbiology lab. The intern notes
that the bacteria growing on the blood agar plate have produced a greenish color and seem to be
inhibited by an optochin disc. They appear shiny. On microscopic examination, there are chains of
spherical gram-positive organisms. On direct testing, the Quellung reaction is positive. What bacteria are
causing the patient’s fever?

A. P. aeruginosa
B. S. aureus
C. Staphylococcus epidermidis
D. S. pneumoniae
E. S. pyogenes

203. An 11-year-old male was recently seen by the pediatrician for spontaneous swelling of his lips. This
was his 4th episode in 2 months, occurring spontaneously without any associative allergens. There was
no tongue swelling, difficulty breathing, rashes, itching or blurry vision during the episodes. The
symptoms lasted for about 5 minutes and relieved without intervention. There was no new introduction
to clothes, detergents, foods or pets. There is no family history of similar problems. His vitals were
within normal limits at the office, and his physical exam was non-significant. On further analysis, he is
diagnosed with a genetic mutation in the SERPING1 gene, and subsequently he is diagnosed with type 1
Hereditary angioedema. A complete analysis of his complement system is performed. Which of the
following statements is most accurate regarding complement system?

A. When comparing C3a and C5a only C5a is produced by all the complement pathways.
B. There are only 2 pathways of complement activation.
C. If C3a and C5a are released in excess amounts, they can lead to shock and death.
D. IgA and IgE are needed to activate classical complement pathway.
E. The expression of CD58 is defective in patients with paroxysmal nocturnal hemoglobinuria.

204. A 40-year-old male patient is brought to the emergency department (ED) after having swelling of
his lips and difficulty breathing. On his way to the ED, the paramedics, administered epinephrine and in
the ED, he was given a bolus of corticosteroids. The symptoms improved and the patient is able to talk
shortly thereafter. He was diagnosed with hypertension 3 days ago, for which he was prescribed
Lisinopril. He took the medicine as prescribed but on the third day he noted that his right hand was
swollen, mildly itching, and tingling. Later, his lips became swollen and had difficulty breathing. Which of
the following statements accurately describes this condition?

A. His symptoms are due to direct activation of mast cells by lisinopril.

B. His symptoms are due to impaired bradykinin degradation by lisinopril.
C. His symptoms are unlikely to recur if he is switched to enalapril.
D. Peripheral blood analysis will show deficiency of C1 inhibitor.
E. Plasma IgE levels are likely to be elevated.

205. A 39-year-old female with a new diagnosis of chronic hepatitis B is visiting the office for routine
check. She denies having fever, jaundice, bleeding, early satiety or bleeding. There is no travel history
and she is currently taking Lamivudine as her therapy. The physical exam does not reveal scleral icterus,
hepatosplenomegaly, bruising, asterixis or edema. Her labs however are concerning for fluctuations in
her LFTs with an abnormal ALT despite a low viral load. Her delta serology is checked and is positive with
a high titre. Which of the following statements is true about the hepatitis D virus (HDV)?

A. All patients with HBV have HDV co-infection

B. HBV-HDV co-infection has the same annual rate of cirrhosis and HCC as HBV mono-infection
C. HDV can infect individuals simultaneously with any acute hepatitis
D. HDV contains a single antigen to which infected individuals make an antibody (anti-HDV)
E. HDV is a DNA virus like HBV

206. A 30-year-old nurse is referred to infectious disease specialist for her persistent, fluctuating
transaminitis (ALT 40-120 U/L) that has been present for several years. She has no history of jaundice,
fever, abdominal pain or bleeding. She does not take any medications or herbal supplements. There is
no travel history out of state. The physical exam does not reveal scleral icterus, hepatosplenomegaly,
bruising, asterixis or edema. What viral infection is most likely?

A. Epstein-Barr virus (EBV)

B. Hepatitis A
C. Hepatitis C
 D. Hepatitis B
E. Hepatitis E

207. A 46-year-old HIV positive woman comes to the clinic with reddish nodules on her
hand and back of the chest. She is not taking any medication. Her laboratory test show
CD4 cell count-47cells/ml, Polymerase chain reaction- RNA viral load 190,000 and PPD
skin test with 5 mm induration. Biopsy of the nodule describes lesion composed of
fibroblast and endothelial-like cells lining vascular space. Which of the following
microorganism would be the cause of this patient ’s skin lesion?
A. Human T cell lymphotropic virus (HTLV-1)
B. Hepatitis C virus (HCV)
C. Human herpesvirus-8 (HHV-8)
D. Epstein-bar virus (EBV)
E. Human papilloma virus (HPV)

208. Staphylococcus aureus sepsis outbreak occurred in the newborn nursery. You are called upon to
investigate. According to your knowledge of the normal flora, what is the most likely source of the
organism?
A. Nose
B. Colon
C. Vagina
D. Throat
E. Skin

209. If a 1:600 dilution of a test compound kills a standard population of Staphylococcus

aureus in 10 minutes but not 5 minutes while a 1:60 dilution of phenol kills the
population in the same time, what is the phenol coefficient of the test compound?

A 1
B 5
C 10
D 50
E 100

210. An experimental compound is discovered that prevents the activation of adenyl

cyclase and the resulting increase in cyclic AMP. The toxic effects of which of the
following bacteria might be prevented with the use of this experimental compound?

A. Vibrio cholerae
B. Corynebacterium diphtheriae
C. Pseudomonas
D. Listeria monocytogenes
E. Brucella
211. A child comes to an emergency room because of an infected dog bite. The wound
is found to contain small Gram-negative rods. The most likely cause of infection is

A. Escherichia coli
B. Haemophilus influenzae
C. Pasteurella multocida
D. Brucella abortus
E. Listeria monocytogenes

212. An immunocompromised patient presents with a brain abscess. The dominant

organism is an aerobe normally found in the environment, particularly in the soil. Which
of the following organism best fits that description?

A Nocardia asteroides
B Actinomyces israelii
C Mycobacterium tuberculosis
D Pseudomonas aeruginosa
E Bacteroides fragilis

213. When repairing a fence on his farm, a 40-year-old man cuts the skin over his chin.
The wound heals without any complication. Four days later, he develops muscle
spasms of the face and extremities. These spasms worsen to the point of contractions.
Which of the Clostridium organism could cause the infection?

A. Clostridium perfringes
B. Clostridium tetani
C. Clostridium difficile
D. Clostridium botulinum
E. All can cause the infection

214. A 10 year old boy showed a PPD test reaction with an area of induration measuring
20 mm. His vaccination record revealed that he had received a BCG vaccine earlier.
What is the interpretation of this test result?

A.The boy was vaccinated with BCG vaccine

B. The boy has no known risk factor
C. The boy is infected with the tubercle bacilli
D. The boy is not infected with the tubercle bacilli
E. The boy is only showing hypersensitivity reaction to the test

215. A 48-year-old man with AIDS is admitted to the hospital with a fever of 38°C
(103°F), night sweats, persistent cough, and prolonged diarrhea. His CD4 cell count is
less than 200/μL. Stool culture reveals the presence of acid-fast bacilli. Which of the
following pathogens is responsible for this patient’s respiratory and gastrointestinal
disease?

A Mycoplasma pneumoniae
B. Chlamydia pneumoniae
C. Mycobacterium avium-intracellulare
D. Mycobacterium leprae
E. Mycobacterium marinum

216. A 2-year-old infant is brought to the emergency room with hemolytic uremic
syndrome (HUS) and thrombocytopenia. Which one of the following bacteria would
most likely be isolated from a stool specimen?

A. Shigella
B. Salmonella
C. Campylobacter
D. E. coli 0157:H7
E. Enterobacter

217. A 24-year-old man presented to the clinic with symptoms resembling plague. He is
suspected of being infected with Yersinia pestis from a flea bite. The patient had never
been vaccinated for the infection before. His blood sample was sent to the lab for
serological test. Result of the covalescent antibody titre was 1 :32. What is the
interpretation?

A Patient is infected with the bacteria

B Patient is not infected with the bacteria
C Patient had previous infection with the bacteria
D Patient is immuned to the serious infection
E Patient has a latent infection

218. A 65 year old man develops dysuria and hematuria. A gram stain of a urine sample
shows gram negative rods. Culture of the urine on EMB agar reveals lactose negative
colonies with evidence of swarming motility and H 2S production. Which one of the
following organisms is most likely to be the cause of his urinary tract infection?

A Enterobacter cloacae
B Pseudomonas aeruginosa
C Proteus vulgaris
D Escherichia coli
E Salmonella typhi

219. A 45-year-old man presents to the clinic complaining of several weeks of vague
abdominal discomfort and early satiety. The physician orders upper gastrointestinal
endoscopy as part of his work-up. During the study, mucosal rigidity and hyperplasia
are seen in the stomach, and a biopsy is taken from the affected area. Microscopic
analysis of the biopsy specimen shows sheets of atypical lymphocytes (B-cell
lymphoma). Which of the listed organism is causing the man’s symptoms?

A. Bacteroides fragilis
B. Prevotella melaninogenica
C. Helicobacter pylori
D. Campylobacter jejuni
E. Salmonella typhi

220. A 32-year-old man presents to his doctor with painful urination and a purulent
urethral discharge typical of non-gonococcal urethritis. The image above shows cells
that have been cultured from this discharge. Inclusions containing glycogen were found
in the cell when stained with iodine. Which of the following organism causes inclusion
containing glycogens and what is the treatment of choice for this infection?
Use the picture to answer question 14 (EB-Elementary body; RB-Reticulate body)

A Chlamydia trachomatis & Azithromycin

B Chlamydia psittaci & Ceftriaxone
C Chlamydia pneumoniae & Fluconazole
D Chlamydia trachomatis & Penicillin
E Chlamydia pneumoniae & Vancomycin
221. An 8-year-old girl with no history of childhood immunizations presents with
pharyngitis and a low-grade fever (38°C). Physical examination reveals a severely
swollen and edematous neck region. Her cervical lymph nodes can be palpated and are
also swollen. Her pharynx is erythematous, and it is painful for her to swallow. The gray
material at the back of her throat caused some bleeding when removed for cultures.
The patient also mentioned not being able to feel the roof of her mouth. Her breath has
an unpleasant odor, and she has a dry cough. An inspiratory stridor is noted upon
auscultation of the lungs. Which of the following is the most likely diagnosis of this
patient’s condition?

A. Diphtheria
B. Pertussis
C. Streptococcal pharyngitis
D. Brucellosis
E. Borreliosis

222. A previously healthy 53-year-old woman develops fever, headache, malaise, and
then cough, which is persistent and worsens over three days. The patient lives in
Missouri, where she works on a dairy farm and tends sheep for wool as an additional
source of income. When evaluated initially in the emergency department, she is found
to be mildly hypoxic and febrile. Her Alanine aminotransferase (AL) is 329 and
Aspartate aminotransferase (AST) is 282. Leukocyte count is 14,000/mm3 (72%
segmented neutrophils, 23% lymphocytes, and 12% monocytes). After admission, her
condition worsens rapidly. She develops progressive renal failure and requires
mechanical ventilation. Chest imaging shows multifocal infiltrates and progressive
pleural effusions, as well as hilar lymphadenopathy. Blood, urine, and sputum culture
are all repeatedly negative repeatedly. She is treated with vancomycin, cefepime, and
metronidazole with no improvement. Infection with what organism is most likely to be
responsible for her current condition?

A Tropheryma whipplei
B Babesia microti
C Borelia lonestari
D Francisella tularensis
E Anaplasma phagocytophilum

223. A previously healthy 22-year-old woman is evaluated in the emergency department

for a complaint of right leg pain so severe that she is barely able to walk. She describes
the pain as extending downward toward her foot and upward toward the lower
abdomen. She reports no recent trauma other than bumping her leg on the edge of a
table earlier in the day. Vital signs at the time are temperature 38.4°C (101.2°F), blood
pressure 90/68 mm Hg, heart rate 108/min, and respiration rate 22/min. She is
immediately taken to the operating room, where operative exploration reveals non-
purulent necrotizing myositis of the muscles of the thigh without evidence gas formation.
A sample of debrided tissue is sent for expedited gram stain to aid antibiotic selection.
Which of the following are most likely to be identified on gram stain analysis?
A Gram-positive rods that are aerobic
B Gram-negative rods that are anaerobic
C Gram-positive cocci in pairs and chains with beta-hemolysis
D Gram-positive cocci in pairs and chains with alpha-hemolysis
E Gram-positive cocci in clusters, with beta-hemolysis
224. A 2-month-old boy is brought to the pediatrician for examination. He has had
several ear infections beginning shortly after birth. On physical examination, his tongue
is noted to be coated with white film. His scalp and face are covered by diffuse
erythematous patches and plaques. Chest radiographs shows absence of thymic
shadow. Flow cytometry is ordered confirming the diagnosis of severe combined
immunodeficiency. Because of the risk of reactivation, administration of which of the
following vaccines should be avoided in this child?
(A) Pneumococcal conjugate vaccine
(B) Diphtheria, tetanus and pertussis vaccine
(C) Rotavirus
(D) Inactivated poliovirus
(E) Hepatitis B

225. A mother brought 12 y/o boy to your attention because he suddenly developed
“the allergic reaction to ampicillin”. The boy complained of fatigue, malaise and sore
throat over the last few days, lost his appetite and is feeling nauseated, but did not
vomit and states that the light causes discomfort in his eyes. The mother noticed
upper eyelids edemas at the beginning of his disease, but not anymore. Rapid strep
test ordered by the pediatrician turned out positive and the pediatrician prescribed
ampicillin. A few hours after that, the patient developed a rash. The boy had no
allergies before. On examination, he is breathing on his mouths, his temperature is 39
o
C, his tonsils are enlarged and almost touching one another, his pharynx is swollen
and red, the uvula is edematous, you notice a few petechiaes on his soft palate and
edemas on both upper eyelids. Posterior and anterior lymph nodes are enlarged, firm,
and mildly tender. There is palpatory tenderness under both left and right rib cage.
You notice a diffuse maculopapular pruritic rash. The blood film showed 33% atypical
lymphocytes. The rest of the examination is normal. What is the most probable cause?
A. Cytomegalovirus infection
B. Human herpesvirus infection
C. Rubella
D. Adenovirosis
E. Anicteric viral hepatitis
F. Epstein-Barr virus infection

226. A 70-year-old man presents to the hospital with a week of fever, chills, nausea,
and right upper quadrant pain (RUQ). He describes the pain to be non-radiating, 7/10
intensity, exacerbated with breathing, and relieved minimally with Tylenol. The
symptoms started suddenly, however, he has had several episodes of same RUQ pain
in the past. He explains that he was admitted few years ago for cholelithiasis but had
declined an elective cholecystectomy. He does not take any medications. He lives with
his wife and performs his daily activities independently. He does not smoke, drink or do
illicit drugs. His temperature is 102 F (39 C), and he appears toxic. His BP is 115/71
mmHg, HR is 115 bpm, and RR is 24 breaths/min with room air SaO2 of 91%. He has
diminished breath sounds at the right lung base and diffuse tenderness in the right
upper quadrant. His CT scan of the abdomen shows a large, complex, multiloculated
liver abscess in the right lobe. Which of the following statements regarding his condition
or therapy is true?
A. Antibiotic therapy targeting Staphylococcus aureus, should be started.
 B. Antibiotic therapy targeting E.coli should be started.
C. Antibiotic therapy targeting Candida albicans, should be started.
D. Antibiotic therapy targeting Actinomyces should be started.
E. Antibiotic therapy against Enterococcus. sp should be started.

227. A 25-year-old woman presents with 2 days of urinary frequency, urgency, and
pelvic discomfort and vaginal discharge. The discharge is clear and is odorless. She
has no pain in her vulva on urination. She has no other medical problems and does not
have fever. She is sexually active with 3 partners within last year. Her vitas are within
normal limits. Her physical exam reveals no skin rash, and the vaginal exam is without
erythema, but there is visible clear cervical discharge that is odorless. A microscopic
examination of her urine shows pyuria but no pathogens. After 24 hours, her urine
culture does not grow any pathogens. Which of the following organisms is most likely to
be the cause of her symptoms?
A. Neisseria gonorrhea
B. Chlamydia trachomatis
C. E. coli
D. Staphylococcus aureus
E. Candida albicans

228. A 40-year-old woman has been hospitalized for 30 days following a stabbing with
penetrating chest and abdominal trauma. She had a right-sided hemopneumothorax as
well as large bowel injury requiring hemicolectomy and hepatic contusion. She
presented in hemodynamic shock and subsequently developed multiorgan failure due to
septic shock. She remains critically ill on mechanical ventilation via a tracheostomy tube
and on hemodialysis. She had been off vasopressors for 1 week but acutely became
febrile over night with a drop in her BP to 72/38 mmHg and HR of 148 bpm. The patient
has new infiltrates on chest radiograph and increased thick yellow secretions from her
tracheostomy tube. Recently, the surgical intensive care unit has had multiple cases of
K. pneumoniae that produce an extended-spectrum β-lactamase (ESBL). Which of the
following statements regarding the ESBL bacteria is true?

A. An ESBL-producing organism is unlikely to be the cause of the patient’s recurrent

sepsis because bacteria that produce ESBL rarely cause ventilator-associated
pneumonia.
 B. An ESBL-producing organism is unlikely to cause the patient’s recurrent sepsis
because the resistance mechanism does not promote easy transmission of
organisms among patients within the intensive care unit.
C. The resistance mechanism in ESBL-producing bacteria is related to a genetic
mutation that passes down generations.
D. The resistance mechanism in ESBL-producing organisms is plasmid-mediated
and is easily passed among bacteria.
E. There is no existing mechanism proposed for ESBL resistance transmission.

229. A 70-year-old male is admitted to the hospital for a fever and cough for 2 days. The
patient lives at nursing home, when the staff found him to be less active and confused.
The patient was noted to have a fever of 102 F (39 C), and tachypneic. He has no other
medical history. He does not drink alcohol, smoke or do illicit drugs. His vitals are 101.8
F (38.8 C), 90/60 mmHg, 110 bpm, and RR of 30/min. He is alert and oriented to place
and person only, lungs exam reveals dullness to percussion to right lower area, but no
wheezing or crackles. His heart exam is tachycardic with regular rhythm and no
murmurs. A blood culture is ordered and the intern taking care of the patient visits the
microbiology lab. The intern notes that the bacteria growing on the blood agar plate
have produced a greenish color and seem to be inhibited by an optochin disc. They
appear shiny. On microscopic examination, there are chains of spherical gram-positive
organisms. On direct testing, the Quellung reaction is positive. What bacteria are
causing the patient’s fever?
A. P. aeruginosa
B. S. aureus
C. Staphylococcus epidermidis
D. S. pneumoniae
E. S. pyogenes