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Infectious Disease
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Ventilator-Associated Pneumonia
Flowchart
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Culture, empiric broad coverage, then narrow to results.
Decision
Outcome
Decision
Suspected VAP (intubated >48 h, new infiltrate, fever, leukocytosis). First step?
✓
Endotracheal sample for culture + microscopy
✗
Empiric oral fluconazole
Decision
After samples obtained — next?
✓
Start empiric antibiotics: anti-pseudomonal β-lactam + second gram-negative agent + MRSA coverage
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Wait for cultures before treating
Decision
Culture result and clinical course?
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Negative cultures → discontinue antibiotics, evaluate other causes
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Positive + clinical improvement → narrow antibiotics
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Positive, no improvement → reassess: change abx, evaluate for empyema/abscess, look for other causes
Outcome
Stop antibiotics; look for non-infectious causes (PE, atelectasis, ARDS)
Outcome
De-escalate by culture; 7-day course usually sufficient
Outcome
Change antibiotics; CT for complications; consult ID