Pearls from presentation 3/21/17 in FMTS by Amber, PharmD:
- Risk factors for MDR HAP, MRSA or Pseudomonas HAP/VAP: IV abx within 90 d.
- Risk factors for MDR VAP: prior abx within 90 d, septic shock at time of VAP, ARDS preceding VAP, ≥5 d hospitalization prior to VAP, dialysis prior to VAP onset.
- Antibiotic regimens:
- Add anti-MRSA agent for units with >10-20% methicillin resistance.
- Do NOT use aminoglycoside as monotherapy.
- Anti-MRSA: vancomycin, linezolid
- Anti-Pseudomonal: pip/taz, cefepime, ceftaz
- Anti-Pseudomonal (PCN allergy): aztreo, cipro, levo, aminoglycosides
- Consider meropenem for hx of ESBL or based on culture data.
- De-escalation: anti-MRSA coverage can be discontinued if cx neg for MRSA at 48-72 hours.
- Double coverage for Pseudomonas recommended for those HAP/VAP pts remaining in septic shock or at high risk of death.
- Duration of therapy for HAP/VAP: 7 days.
- Procalcitonin use:
- Do not wait on procal results to initiate abx tx – depend on clinical criteria.
- Use procal to determine when to STOP antibiotic coverage:
- Resp tract: 0.1 – 0.25 ng/mL = low likelihood for bacterial infx; > 0.25 = increased likelihood.
- Sepsis: 0.1 – 0.5 = low likelihood; > 0.5 = increased likelihood; > 2.0 = high risk of sepsis/septic shock