A 68-year-old male with COPD on home oxygen presents to the emergency department with acute exacerbation of bronchiectasis. Sputum culture grows Pseudomonas aeruginosa sensitive to piperacillin-tazobactam, ceftazidime, fluoroquinolones, and aminoglycosides but resistant to carbapenems. Chest X-ray shows bilateral bronchial wall thickening and bronchiectatic changes. What is the most appropriate next step in management?

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