Hospital Acquired Pneumonia

Hospital Acquired Pneumonia


  • Pneumonia that develops 48 hours or more after admission to hospital
  • Ventilator-associated pneumonia is excluded. Please refer to ventilator-associated pneumonia guidelines.
  • A diagnosis of HAP generally requires:
    • demonstration of an infiltrate on chest imaging; AND
    • compatible signs or symptoms, such as: dyspnea/tachypnea/hypoxia, cough, purulent sputum, or fever.

Microbiological analyses:

  • blood cultures x 2 sets
  • sputum culture
  • ± S. pneumoniae urinary antigen
  • ± Legionella urinary antigen
  • For patients with HAP requiring intubation, a culture of endotracheal secretions is recommended.

Other analyses:

  • Serial procalcitonin levels, in combination with clinical evaluation, may assist in the decision to initiate or discontinue antibiotics.

Empiric Therapy

  • No risk factors for multidrug resistant (MDR) Gram-negative organism or poor outcomes

Presence of ANY ONE of the following risk factors for MDR Gram-negative pathogens or poor outcomes:

  • Requiring ICU care: septic shock and/or mechanic intubation
  • In ICU when symptoms appear, or transferred from ICU in the last 48 hours
  • Prior intravenous antibiotic use within 90 days
  • Immunosuppression
  • Structural lung disease (e.g., bronchiectasis, cystic fibrosis)
  • Colonization or recent prior infection with Pseudomonas or other resistant Gram-negative bacilli (e.g., ESBL or AmpC)

Other Treatment Considerations

More Information

Guideline content derived from:

  • NB Provincial Health Authorities Antimicrobial Stewardship Committee. Antimicrobial Treatment of Hospital Acquired Pneumonia (HAP). 05-2023
  1. Kalil AC et al. Management of Adults with Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clinical Infectious Diseases. 2016; 63: 1-51
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  3. Blondel-Hill E. & Fryters S. (2012). Bugs & Drugs. An Antimicrobial/Infectious Diseases Reference. Alberta Health Services.
  4. MSH+UHN Antimicrobial Stewardship Program. Hospital Acquired Pneumonia. Accessed online 12-2016.
  5. Management of Penicillin and Beta-Lactam Allergy. NB-ASC. 09-2017
  6. Adult Antimicrobial Dosing Tool. NB-ASC. 03 – 2023
  7. Torres A et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J. 2017 Sep 10;50(3):1700582. doi: 10.1183/13993003.00582-2017. PMID: 28890434.
  8. Kumar A, et al. A survival benefit of combination antibiotic therapy for serious infections associated with sepsis and septic shock is contingent only on the risk of death: a meta-analytic/meta-regression study. Crit Care Med. 2010 Aug;38(8):1651-64. doi: 10.1097/CCM.0b013e3181e96b91. PMID: 20562695.
  9. Firstline Antimicrobial Stewardship App.  Nova Scotia Health Authority; Fraser Health; Providence Health Care – Accessed 15/03/2023