Hospital-Acquired (HAP) and Ventilator-Associated (VAP) Pneumonia Updates

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.
    • Options:
      • 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
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