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

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


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