Hospital- and Ventilator-Associated Pneumonia
GENERAL PRINCIPLES
The most frequent pathogens are gram-negative bacilli and S. aureus.
DIAGNOSIS
Clinical Presentation
• Hospital-acquired pneumonia (HAP) is defined as pneumonia occurring ≥48 hours after admission that was not incubating at the time of admission.
• Ventilator-associated pneumonia (VAP) is defined as HAP developing >48-72 hours after endotracheal intubation and mechanical ventilation.
• In addition to new or progressive pulmonary infiltrate, patients may present with fever, purulent respiratory secretions, tachypnea, and hypoxia.
Diagnostic Testing
• Diagnosis is made by clinical criteria as well as microbiologic testing.
• Noninvasive respiratory sampling (e.g., spontaneous expectoration, sputum induction, nasotracheal suctioning) is recommended to establish a microbiologic diagnosis of HAP prior to initiating empiric treatment. Likewise, noninvasive sampling comprised of endotracheal aspiration with semiquantitative culture can serve as first step over bronchoscopy aspirates (e.g., BAL, blind bronchial sampling) to aid in diagnosis of VAP.57
TREATMENT
• Initial empiric antimicrobial therapy should cover S. aureus (including MRSA) and P. aeruginosa. Targeted therapy should be based on culture results and in vitro sensitivity testing.58
• Empyemas require drainage.