Hospital acquired pneumonia (HAP)
Hospital acquired pneumonia occurs in patients with ≥
48 hours spent in hospital.
Non-Ventilator associated pneumonia (Non-VAP)
Bottom Line
- If severe presentation (hypotension, intubation, sepsis syndrome, rapid progression of infiltrates or end organ damage) plus or minus risk factors for resistance (antimicrobial therapy in the past 90 days or late-onset during hospitalization (>5days)); then one can consider anti-pseudomonal coverage or coverage for methicillin-resistant Staphylococcus aureus (MRSA). Based on the KGH antibiogram, we suggest ceftazidime and vancomycin respectively
- Core pathogens include: Streptococcus pneumoniae, Streptococcus species, Escherichia coli, Enterobacter species, Haemophilus influenzae, Proteus species, Serratia marcescens, Klebsiella species, methicillin-susceptible Staphylococcus aureus
Ventilator associated pneumonia (VAP)
Bottom Line
Empiric Therapy
- If no risk factors for resistance: ceftriaxone or respiratory fluoroquinolone (FQ)
- Risk factors for resistance or severe presentation: consider coverage for Pseudomonas aeruginosa, MRSA, Acinetobacter species, Stenotrophomonas maltophilia , or Legionnella species