A 63-year-old male, post head trauma, is intubated and has been mechanically ventilated for 78 hours

The respiratory therapist notes the following during ICU rounds: partial pressure of oxygen in the arteries (PaO2) is 82 mm Hg on 60% supplemental oxygen with a positive end-expiratory pressure (PEEP) of 8 cm H2O; static compliance is averaging 38-41 cm H2O/L; breath sounds are dimin-ished bilaterally. Bronchoalveolar lavage (BAL) results are pending, but MRSA is suspected. Chest radiograph shows bilateral, patchy infiltrates. Patient has a temperature of 38.8° C, and the most recent white blood cell (WBC) count is 11,300 ?L. The most appropriate recommendation for this patient is which of the following?
a. Monotherapy with an antipseudomonal carbepenem
b. Monotherapy with an antipseudomonal fluoroquinolone
c. Combination therapy with two types of antipseudomonal agents and vancomycin
d. Combination therapy with ampicil-lin/sulbactam and linezolid

ANS: C
This patient has late-onset ventilator-associated pneumonia because he has been intubated and has received mechanical ventilation for longer than 72 hours. Because MRSA is suspected, com-bination antibiotic therapy should be used. According to Table 14-2 this would include two an-tipseudomonal agents plus either vancomycin or linezolid. Therapy should be adjusted once the microbiological data confirm the organism.