Ventilator-Associated Pneumonia and Hospital-Acquired Pneumonia

Microbiology

See below for MRSA/PsA information. In addition, Atypical bacteria (e.g. Mycoplasma, Chlamydiae, Legionella) don't generally cause VAP.  Consequently, atypical coverage is generally not utilized. Anaerobic coverage for pulmonary infections is generally indicated only in the context of empyema or lung abscess.

Diagnosis

Clinical Picture

Definitions

Investigations

Differential

Always thinking about these! Viral pneumonia, ARDS, atelectasis, pulmonary edema, aspiration pneumonitis, pulmonary embolism with infarction, interstitial lung disease (e.g. COP, AIP).

Antimicrobial Therapy

Hospital-Acquired Pneumonia

Ventilator-Associated Tracheobronchitis

Ventilator-Associated Pneumonia

Inhaled antibiotic therapy

Proven MRSA HAP/VAP

Treat with vancomycin or linezolid.

Proven Pseudomonas HAP/VAP

Proven ESBL HAP/VAP

Proven Acinetobacter HAP/VAP

Proven Carbapenem-resistant pathogens

Duration of Therapy

De-escalation and Discontinuation

References

  1. 2016 IDSA/ATS HAP/VAP Guidelines
  2. Ventilator Associated Pneumonia (VAP) - EMCrit Project