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)