Ventilator Associated Pneumonia

Ventilator Associated Pneumonia

Pneumonia occurring ≥ 48 hours after mechanical ventilation

Diagnosis and Management

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

  • Fever

  • Purulent respiratory secretions

  • Leukocytosis

  • Increase in oxygen requirements or ventilatory settings

  • Sputum culture: Endotracheal aspiration is generally preferred over invasive sampling (e.g. bronchoalveolar lavage)

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

  • 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.

  • Antimicrobial therapy should be narrowed based on microbiology of respiratory samples.

  • Stenotrophomonas maltophilia can cause VAP and should be suspected if patients is not improving despite broad-spectrum antimicrobial therapy. Trimethoprim/sulfamethoxazole is the antibiotic of choice.

  • Candida is a very rare cause of pneumonia and does not require treatment unless evidence of systemic infection such as bloodstream infection.

  • Respiratory cultures can continue to be positive despite successful treatment; avoid repeating cultures if patient is clinically improving.

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. www.nice.org.uk/guidance/ng138. Accessed March 13, 2020.
  3. Ventilator-Associated Pneumonia. SHS + UHN Antimicrobial Stewardship Program, 2020. https://www.antimicrobialstewardship.com/community-acquired-pneumonia. Accessed March 13, 2020.
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