A 45-year-old man is admitted to the ICU following complicated abdominal surgery with anastomotic repair. On hospital day 5, he develops fever (38.9°C), tachycardia (heart rate 110/min), and tachypnea (respiratory rate 22/min) while on mechanical ventilation. Endotracheal suctioning yields copious purulent secretions. Chest X-ray shows a new infiltrate in the right lower lobe. Gram stain of endotracheal aspirate demonstrates gram-negative rods. Laboratory studies show WBC 14,500/μL and normal renal function. The patient has received only perioperative cefazolin prophylaxis. Which of the following is the most appropriate initial empiric antibiotic regimen?
- A)Ceftriaxone and gentamicin
- B)Ampicillin-sulbactam monotherapy
- C)Piperacillin-tazobactam plus a respiratory fluoroquinoloneGABARITO
- D)Clindamycin and tobramycin
- E)Azithromycin monotherapy
Explicação
This patient has ventilator-associated pneumonia (VAP), defined as pneumonia occurring ≥48 hours after intubation. VAP empiric coverage must target Pseudomonas aeruginosa and other resistant gram-negative organisms (ESBL-producing Enterobacteriaceae, Acinetoba... Ver explicação completa e trilha adaptativa →