Refers to pneumonia occurring ≥ 48h after endotracheal intubation
Diagnosis of pneumonia is generally based on suggestive clinical features (cough, fever, sputum production, pleuritic chest pain, dyspnea) and a new chest x-ray infiltrate.
Note: there is NO gold standard for the definitive diagnosis of pneumonia.
OR, IF Immunocompromised or known ESBL/AmpC
IF AT RISK FOR MRSA ADD
7 days sufficient for the vast majority of VAP, including Pseudomonas. Guidelines no longer recommend prolonged treatment.
Therapy may be extended based on slow clinical improvement, or radiological and laboratory parameters.
Pseudomonas, Acinetobacter, Stenotrophomonas and Staph aureus HAP/VAP may require longer duration of treatment.
Empiric vancomycin can be discontinued if the nasal MRSA swab is negative, and no MRSA is identified in blood or sputum cultures
If microbiological results are POSITIVE, follow culture-directed therapy