Hospital Acquired Pneumonia

Hospital Acquired Pneumonia

Pneumonia not present at the time of hospital admission and occurring ≥ 48 hours after admission

Diagnosis and Management

Suspect HAP if chest imaging shows new pulmonary infiltrate, PLUS one of:

  • Fever

  • Purulent respiratory secretions

  • Leukocytosis

  • Dyspnea or increase in oxygen requirements

  • Sputum culture

  • Blood cultures (aerobic and anaerobic) x 2 sets using two sites, at least one from a peripheral site

  • Aspiration pneumonitis: antimicrobial therapy is not indicated for acute macroaspiration events. Pneumonia may develop, reassess after 48 hours.

  • Aspiration pneumonia: routine addition of anaerobic coverage, such as metronidazole, is not recommended unless treating an empyema or lung abscess.

  • Consider double antimicrobial coverage for Pseudomonas only if critically ill with high suspicion of infection with resistant microorganism in patients who have received recent broad spectrum antimicrobial therapy. Narrow to single agent once sensitivities available.

More Information

  1. Kalil AC, Metersky ML, Klompas M, Musced-ere J, Sweeney DA, Palmer LB, et al. 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. Clin Infect Dis. 2016; 63: pp e61-e111.
  2. National Institute for Health and Care Excellence. Pneumonia (hosptial-acquired): antimicrobial prescribing. NICE Guideline. 2019. Accessed March 13, 2020.
  3. Management of Hospital-Acquired Pneumonia in Adults. SHS + UHN Antimicrobial Stewardship Program, 2018. Accessed March 13, 2020.
  4. Treatment Guidelines. Sunnybrook Health Sciences Centre. Accessed April 5, 2020.
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