Hospital Acquired Pneumonia
Clinical Pearls

Clinical Pearls

Clinical Pearls

Recent studies have shown that, compared with standard treatment durations of 10 days or more, 7-day treatment durations were associated with fewer relapses caused by multiresistant pathogens WITHOUT affecting mortality rate

To avoid prolonged use of broad-spectrum antibiotics, it is essential to de-escalate therapy according to the results of microbiologic analyses

For patients with HAP requiring intubation, a culture of endotracheal secretions is recommended

  • Empiric coverage of atypical organisms (e.g. Legionella, Mycoplasma) is generally not recommended
  • Consider atypical coverage if nosocomial outbreak of Mycoplasma or Legionella
  • Empiric double coverage of Pseudomonas aeruginosa to maximize the likelihood of having at least one active agent (due to increased risk of resistance with Pseudomonas).
  • If Pseuodomonas is isolated, step-down to monotherapy (according to susceptibility data)
  • Use of aminoglycosides (e.g. tobramycin and gentamicin) as monotherapy for the treatment of pneumonia is NOT recommended (even if susceptibility is confirmed)
  • DO NOT use DAPTOmycin to treat pneumonia; DAPTOmycin is inactivated by pulmonary surfactant.
  • If MRSA infection, use vancomycin (or linezolid if vancomycin is ineffective or inappropriate)

Serial procalcitonin levels (if available), in combination with clinical evaluation, may assist in the decision to discontinue antibiotics