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

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

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
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