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Evidence for diagnosis and next steps
Vincent’s diagnosis is VAP
The clinical evidence for this is:
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Fevers
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Productive respiratory secretions
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Worsening leukocytosis
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Requires increased oxygenation
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Had ronchi on auscultation
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Has new infiltrates on the chest x ray
And once you suspect VAP the next steps are:
Determine the causative organism
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Obtaining respiratory cultures or
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molecular diagnostics if available (multiplex PCR)
Start empiric antibiotics targeting the most likely pathogens
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In the case of hospitalised patients with VAP the cause might vary depending on where is your practice and local patterns of antibiotic resistance.
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Gram negative organisms are an important cause of VAP.
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In some areas Staph. aureus resistant to methicillin (MRSA) could also be implicated.
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