Hospital-acquired and ventilator-associated pneumonia Quiz: Ace Your Exams

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A 53-year-old woman with acute pancreatitis is admitted to the hospital. She is given intravenous fluid resuscitation and pain control. The patient’s hospital course is complicated by acute respiratory distress syndrome on day 2 requiring mechanical ventilation. She clinically improves over the next few days and is gradually weaned off the ventilator. However, on day 6 of her hospital stay, ventilator settings are increased to optimize oxygenation. Temperature is 39.0°C (102.2°F), blood pressure is 110/75 mmHg, pulse is 122/min, respiratory rate is 20/min, and oxygen saturation is 92% on 60% FiO2 with a positive end-expiratory pressure of 8 cm H2O. On physical examination, rales are noted throughout the lungs and are significantly louder over the right lower lung field. A point-of-care ultrasound reveals a new subpleural consolidation and dynamic air bronchograms in the right lower lobe, along with findings consistent with ARDS in other lobes. Purulent secretions are obtained from the endotracheal tube. The prevalence of methicillin-resistant Staphylococcus aureus at this hospital is unknown. The patient should be started on which of the following antibiotic regimens?  

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