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Guidelines
Ventilator-Associated Pneumonia (VAP)

Ventilator-Associated Pneumonia (VAP)

Background

  • Pneumonia that develops 48 hours or more after endotracheal intubation
  • A diagnosis of VAP generally requires:
    • demonstration of an infiltrate on chest imaging; AND
    • compatible clinical features, such as: fever, tachypnea, increased purulent secretions, increased in oxygen requirements or ventilatory settings, or leukocytosis.

Microbiological analyses:

  • blood cultures x 2 sets
  • endotracheal suctioning for culture

Other analyses:

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

Empiric Therapy

Patient WITHOUT Risk Factors:
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No risk factors for multidrug resistant (MDR) Gram-negative organism or poor outcome

Patient WITH Risk Factor(s) (ANY ONE):
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Presence of ANY of the following risk factors for MDR Gram-negative pathogens or poor outcomes:

  • Severe sepsis or septic shock
  • Prior intravenous antibiotic use within 90 days
  • Immunosuppression
  • Structural lung disease (e.g., bronchiectasis, cystic fibrosis)
  • Hospitalization for greater than or equal to 5 days before VAP onset
  • Acute renal replacement therapy before VAP onset
  • Acute respiratory distress syndrome (ARDS) before VAP onset
  • Colonization or recent prior infection with Pseudomonas spp or other resistant Gram-negative bacilli (e.g., ESBL or AmpC)

Other Treatment Considerations

  • Defined as fever with no other recognizable cause, with new or increased sputum production, positive ETA culture yielding a new bacteria, and no radiographic evidence of nosocomial pneumonia.
  • Should not routinely be treated.
  • Only consider initiating antimicrobial therapy if clinical deterioration (e.g., progressive hypoxemia).

More Information

Guideline content derived from:

  • NB Provincial Health Authorities Antimicrobial Stewardship Committee. Antimicrobial Treatment of Ventilator Associated Pneumonia (VAP). 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
  2. Pugh R, Grant C, Cooke RP, Dempsey G. Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults. Cochrane Database Syst Rev 2015; 8:Cd007577
  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