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.