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Hospital Acquired Pneumonia
ICU Patient

ICU Patient

Management

Consider treatment modification if patient is at risk of resistant organisms (i.e. recent antimicrobial therapy or structural lung disease, prior culture)

  • Previous infection or colonization with Pseudomonas aeruginosa
  • Recent ICU admission or prolonged mechanical ventilation
  • Profound Immunosuppression (ie. transplant patient or febrile neutropenia)
  • Prior use of IV antibiotics in past 90 days
  • Structural lung disease (ie. bronchiectasis, cystic fibrosis, severe COPD)
  • High risk for mortality (i.e. need for ventilator support due to pneumonia and septic shock)

Tailor antibiotic therapy based on culture results

Consider discontinuation of antibiotics, if alternative, non-infectious diagnosis is made

If patient is immunocompromised or recent travel history, patient may be at risk of unusual or opportunistic pathogens, Consider Infectious Disease Consult

Low Pseudomonas Risk

OR

OR

Levofloxacin 750mg PO daily
​
  • If true SEVERE Beta-lactam allergy
  • Use IV if unable to take PO

IF MRSA RISK FACTORS, ADD

Vancomycin IV
​

Per order set

High Pseudomonas Risk

OR

Meropenem 500mg IV q6h
​

If true SEVERE Beta-lactam allergy

IF MRSA RISK FACTORS, ADD

Vancomycin IV
​

Per order set

Duration

  • 7 Days
  • Can consider longer duration of treatment for immunocompromised patients or in certain clinical conditions depending on rate of improvement of clinical parameters

Consider safe transition to oral therapy once:

  • Hemodynamically stable
  • Improving clinically
  • Afebrile for 24 hrs.
  • Can ingest oral meds and have functioning GI tract