Hospital Acquired Pneumonia

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

Empiric Therapy

Ceftriaxone or respiratory fluoroquinolone (FQ)

Ventilator associated pneumonia (VAP)

Bottom Line

Treatment is based upon risk factors for resistance and severity of presentation.
Risk factors for resistance include antimicrobial therapy in the past 90 days or late-onset during hospitalization (>5days).
For multi-drug resistant organisms, look at microbiology section regarding resistance data.

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

Share by: