Guidelines
Ventilator-Associated Pneumonia

Ventilator-Associated Pneumonia

Clinical Considerations

Pneumonia occurring > 48 hours after endotracheal intubation

  • Should be obtained prior to starting or changing antibiotics
  • Endotracheal aspirate or bronchoscopic specimen if possible

Antibiotic selection is based on local prevalence of pathogen resistance and risk factors for MDR pathogens

MRSA coverage recommended when:

  • MRSA rate >10%
  • Admitted to units where prevalence unknown

Consider double coverage for Pseudomonas aeruginosa when:

  • >10% of isolates are resistant to a single agent (tobramycin should not be used alone)
  • Where local ICU susceptibility rates are unknown
  • Risk factors for antimicrobial resistance present:
    • Prior IV antibiotic use within 90 days
    • Acute renal replacement therapy prior to VAP onset
    • Septic shock at time of VAP
    • ≥5 days of hospitalization prior to VAP occurrence
    • ARDS preceding VAP
    • Structural lung disease (i.e. bronchiectasis or cystic fibrosis)
  • If Culture Positive
    • De-escalate therapy as soon as culture results available
      • D/C vancomycin if MRSA not isolated
      • D/C second ‘Gram-negative’ antibiotic
  • If Culture Negative
    • Consider alternative sources and narrow therapy
  • Enterococci and Candida often isolated from sputum
    • Considered colonizing organisms
    • Do NOT treat
  • Benefits studied in treatment of P. aeruginosa infections show conflicting data
  • Benefits only shown using combination of a beta-lactam plus an aminoglycoside, which may increase risk of nephrotoxicity
  • For patients with HAP/VAP due to P. aeruginosa and results of antibiotic susceptibility testing are known:
    • Monotherapy (except aminoglycosides) recommended for those NOT in septic shock/high risk for death

Microbiology

More Information

  1. IDSA Guidelines for HAP/VAP. Clin Infect Dis 2016.
  2. Giancola SE, et al. Diag Microbiol Infect Dis 2016.
  3. Chan JD, et al. Crit Care Med 2012;40:1437-1442.