The probability of harming the kidneys with these antibiotics is substantial, whereas the probability of randomly hitting a multidrug-resistant pathogen may be lower. Specifically, if the patient probably doesn't have VAP, then it may not be wise to unleash a toxic cocktail of vancomycin, cefepime, and an aminoglycoside. The fact that our clinical diagnosis of VAP will often be wrong should lead to some restraint regarding the initial antibiotic regimen. To make matters even more complicated, VAP may have a significant attributable mortality (perhaps ~10%) – so we do need to take it seriously, and treat it properly. Consequently, we are doomed to usually be wrong when we make the initial diagnosis of VAP. Likewise, all of the early diagnostic indicators of VAP have poor test performance (e.g., fever, leukocytosis, sputum production, and chest radiograph). Studies consistently show that among patients who are clinically diagnosed with VAP, only ~40-50% will eventually be found to have VAP based on microbiological studies.
Overinvestigation: Broad use of bronchoscopy and CT scan for every patient with a pulmonary infiltrate. Underinvestigation: Assuming the diagnosis of VAP without any sophisticated studies. Underinvestigation versus overinvestigation. Overtreatment: Treating every patient with possible VAP using numerous broad-spectrum antibiotics. Undertreatment: Overlooking the diagnosis until the patient develops septic shock. Clinicians must walk several fine lines regarding VAP: Ventilator associated pneumonia (VAP) is pneumonia occurring more than two days after intubation. Step #5 – Narrowing the antibiotic regimen based on microbiological studies. Step #4 – Data review & diagnosis adjudication. Step #2 – Pulling the trigger on antibiotics & cultures. Step #1 – Rapidly available information –> Does the patient have probable VAP?. In contrast, enteral rehydration was more rapidly achieved in patients with gastroenteritis due to rotavirus. 022), despite the more-frequent dehydration observed among children with rotavirus versus those with astrovirus or calicivirus gastroenteritis (P =. Mean duration of hospitalization was statistically significantly lower for children with rotavirus gastroenteritis (P =. Median age was higher for patients with rotavirus gastroenteritis than it was for those with astrovirus or calicivirus gastroenteritis (P =. Virologic tests revealed rotavirus in 17.3% of samples, calicivirus in 7.3%, astrovirus in 6.8%, adenovirus in 0.7%, and ≥1 virus in 5.4%. 
Of the 438 stool samples obtained, 138 tested positive for ≥1 pathogen during the winters of 99 (P <.
A stool sample obtained from each child was analyzed for the presence of astrovirus, calicivirus, rotavirus, adenovirus, enterovirus, and digestive bacteria. This study assessed the epidemiologic characteristics of acute viral gastroenteritis in hospitalized children.
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