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What next?

Evidence for diagnosis and next steps

Vincent’s diagnosis is VAP

The clinical evidence for this is:

  • Fevers

  • Productive respiratory secretions

  • Worsening leukocytosis

  • Requires increased oxygenation

  • Had ronchi on auscultation

  • Has new infiltrates on the chest x ray

And once you suspect VAP the next steps are:

Determine the causative organism

  • Obtaining respiratory cultures or

  • molecular diagnostics if available (multiplex PCR)

Start empiric antibiotics targeting the most likely pathogens

  • In the case of hospitalised patients with VAP the cause might vary depending on where is your practice and local patterns of antibiotic resistance.

  • Gram negative organisms are an important cause of VAP.

  • In some areas Staph. aureus resistant to methicillin (MRSA) could also be implicated.

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Challenges in Antibiotic Resistance: Gram Negative Bacteria


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