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

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

Microbiology

Clinical Considerations

HAP: Pneumonia not incubating at time of hospital admission, occurring 48 hours or more after admission

VAP: Pneumonia occurring > 48 hours after endotracheal intubation

  • Prior IV antibiotic use within 90 days

  • Septic shock at time of VAP

  • ARDS preceding VAP

  • Five or more days of hospitalization prior to the occurrence of VAP

  • Acute renal replacement therapy prior to VAP onset

  • Need for ventilator support

  • Presence of septic shock

Pulmonary Symptoms

  • Cough

  • Dyspnea

  • Tachypnea

  • Crackles or rales

  • Hypoxemia

  • Sputum production

Systemic Symptoms

  • Fever

  • Leukocytosis

  • Chills

  • Fatigue

  • Tachycardia

Chest X-Ray

  • Single or multi-lobe involvement with consolidations, opacities, and/or interstitial infiltrates
  • Clinical criteria
  • Blood cultures are recommended for all patients with HAP/VAP
  • Non-invasive respiratory cultures (e.g. sputum) are recommended for all patients with HAP/VAP
  • Biomarkers are not recommended for diagnosis

Treatment

References

Andre C. Kalil, Mark L. Metersky, Michael Klompas, John Muscedere, Daniel A. Sweeney, Lucy B. Palmer, Lena M. Napolitano, Naomi P. O'Grady, John G. Bartlett, Jordi Carratalà, Ali A. El Solh, Santiago Ewig, Paul D. Fey, Thomas M. File, Jr, Marcos I. Restrepo, Jason A. Roberts, Grant W. Waterer, Peggy Cruse, Shandra L. Knight, Jan L. Brozek. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciw353. 2016. Accessed November 11, 2019:61-111.