Hospital-acquired pneumonia (HAP): Acute illness affecting the lungs caused by pathogens in the hospital setting and presenting 48 hours or more after admission
Ventilator-associated pneumonia (VAP): Acute illness affecting the lungs caused by pathogens in the hospital setting and presenting 48 hours or more after admission while the patient is on a ventilator
Important
The cut-off of 48 hours is chosen for convenience and surveillance purposes
Non-ventilated patients: New or worsening cough +/- sputum production, difficult and rapid breathing, reduced oxygen saturation, crepitations on lung auscultation, or chest pain/discomfort with no alternative explanation; fever ≥38.0°C usually present (may be absent, especially in the elderly)
Ventilated patients: Increased respiratory secretions, reduced oxygen saturation and a new lung infiltrate on a chest-radiograph
Note: the clinical presentation is non-specific and other diseases (e.g. pulmonary embolism) can mimic HAP. HAP/VAP may progress to sepsis
All cases:
Selected cases (depending on epidemiology and risk factors):
Important: a positive respiratory culture may indicate colonization rather than acute infection
Determine disease severity: Blood pH and gases, white blood cell count
Differentiate bacterial and viral (taking into account pre-test probability): C-reactive protein and/or procalcitonin
Note: tests depend on availability and clinical severity (e.g. blood gases will only be done in severe cases)
Chest radiograph needed because other conditions have similar clinical features and antibiotics may be avoided if bacterial pneumonia is not suggested
Important:
Key principles:
Bundles of care specific to the ICU also usually include: