Hospital-Acquired Pneumonia

A 75-year-old woman develops hospital-acquired pneumonia 4 days after being admitted for a hip fracture. She has a fever, increased purulent sputum, and shortness of breath. Her temperature is 38.2C, respiratory rate is 26 breaths/min, and oxygen saturation is 88% on room air. She has no known drug allergies.

What is the most appropriate initial antibiotic therapy for this patient?

A 60-year-old man is admitted to the ICU for septic shock secondary to a perforated bowel. He has been on mechanical ventilation for 7 days. His condition has improved, but today he develops a fever of 38.3C and increased purulent secretions from the endotracheal tube. On examination, his blood pressure is 120/70 mmHg, heart rate is 100 bpm, and oxygen saturation is 94% on 40% FiO2. Blood tests reveal a white blood cell count of 18 x 10^9/L. A chest X-ray shows new infiltrates in the right middle and lower lobes.

Which of the following is the gold standard for diagnosing ventilator-associated pneumonia (VAP) in this patient?

A 65-year-old man develops a fever, productive cough, and dyspnea seven days after admission for a hip replacement. His chest X-ray shows new infiltrates, and his sputum culture is positive for Klebsiella pneumoniae.

What is the most appropriate antibiotic treatment for his hospital-acquired pneumonia?

A 60-year-old woman develops fever, productive cough, and dyspnea six days after admission to the ICU for severe pancreatitis. She is on mechanical ventilation. Her sputum culture grows a non-fermenting gram-negative bacillus.

What is the most likely causative pathogen for her hospital-acquired pneumonia?

A 65-year-old man with a history of chronic obstructive pulmonary disease (COPD) is admitted to the hospital for an acute exacerbation. After 5 days in the hospital, he develops a new fever, increased sputum production, and worsening dyspnea. His temperature is 38.3C, respiratory rate is 24 breaths/min, and oxygen saturation is 90% on room air. Chest auscultation reveals new crackles and rhonchi.

What is the most appropriate initial investigation to confirm the diagnosis of hospital-acquired pneumonia?