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Guidelines
Hospital-Acquired (HAP) & Ventilator-Associated Pneumonia (VAP)

Hospital-Acquired (HAP) & Ventilator-Associated Pneumonia (VAP)

Pearls

Always get respiratory cultures when starting antibiotics

Should be started with the commitment to obtain Respiratory Cultures and perform serial clinical assessments to aid in antibiotic de-escalation to limit resistance and toxicity

  • MRSA accounts for ~50% of all S. aureus pneumonia isolates necessitating empiric coverage due to high prevalence at AHT
  • Discontinue Anti-MRSA antibiotic if MRSA is not isolated on respiratory culture or low suspicion for MRSA pneumonia clinically
  • MRSA nares PCR screenings may help if the patient has not received decolonization treatment (i.e. mupirocin)
  • Empiric Pseudomonas double-coverage should be limited to patients with MDR Pseudomonas Risk Factors (see below)
  • Definitive Pseudomonas double-coverage is recommended during septic shock or high risk of death (>25%)
    • Upon resolution monotherapy is recommended

Additional Resources

  • Intravenous antimicrobial therapy in preceding 90 days
  • Septic shock at time of diagnosis
  • Ventilatory support due to pneumonia
  • ARDS preceding diagnosis
  • Current hospitalization of 5 days or more
  • Acute renal replacement therapy preceding diagnosis
  • Severe bronchiectasis or cystic fibrosis