Hospital-Acquired, Health Care-Associated, and Ventilator-Associated Pneumonia Organism-Specific Therapy 

Updated: Jan 16, 2015
  • Author: Ryan C Maves, MD, FACP, FCCP, FIDSA; Chief Editor: Thomas E Herchline, MD  more...
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Specific Organisms and Therapeutic Regimens

Organism-specific therapeutic regimens for hospital-acquired pneumonia (HAP), health care–associated pneumonia (HCAP), and ventilator-associated pneumonia (VAP) are provided below, including those for Pseudomonas aeruginosa, Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible S aureus (MSSA), Legionella pneumophila, Acinetobacter baumannii, and Stenotrophomonas maltophilia. [1, 2]

Definitions

See the list below:

  • HAP: Diagnosis made more than 48 hours after admission
  • VAP: Diagnosis made 48-72 hours after endotracheal intubation
  • HCAP: Diagnosis made less than 48 hours after admission with any of the following risk factors: (1) hospitalized in an acute care hospital for more than 48 hours within 90 days of the diagnosis; (2) resided in a nursing home or long-term care facility; (3) received recent IV antibiotic therapy, chemotherapy, or wound care within the 30 days preceding the current diagnosis; and (4) attended a hospital or hemodialysis clinic

Pseudomonas aeruginosa

See the list below:

  • Piperacillin-tazobactam 4.5 g IV q6h (standard infusion) or 4.5 g IV q8h (infused over 4 hours) plus  ( gentamicin 7 mg/kg/day IV, tobramycin 7 mg/kg/day IV, or amikacin 20 mg/kg/day IV) plus  ( ciprofloxacin 400 mg IV q8h or levofloxacin 750 mg IV q24h) or
  • Cefepime 2 g IV q8h plus  (gentamicin 7 mg/kg/day IV, tobramycin 7 mg/kg/day IV, or amikacin 20 mg/kg/day IV) plus  (ciprofloxacin 400 mg IV q8h or levofloxacin 750 mg IV q24h) or
  • Imipenem 1 g q6-8h plus  (gentamicin 7 mg/kg/day IV, tobramycin 7 mg/kg/day IV, or amikacin 20 mg/kg/day IV) plus  (ciprofloxacin 400 mg IV q8h or levofloxacin 750 mg IV q24h) or
  • Meropenem 2 g IV q8h (standard infusion or infused over 3 hours) plus  (gentamicin 7 mg/kg/day IV, tobramycin 7mg/kg/day IV, or amikacin 20 mg/kg/day IV) plus  (ciprofloxacin 400 mg IV q8h or levofloxacin 750 mg IV q24h) or
  • Aztreonam 2 g IV q8h plus  (gentamicin 7 mg/kg/day IV, tobramycin 7 mg/kg/day IV, or amikacin 20 mg/kg/day IV) plus (ciprofloxacin 400 mg IV q8h or levofloxacin 750 mg IV q24h)
  • Duration of therapy: 14 days
  • Data are limited concerning the benefit of combination therapy for pseudomonal infections; when antimicrobial drug susceptibility results are known, it is reasonable to continue a single active beta-lactam agent and to discontinue the accompanying fluoroquinolone or aminoglycoside

Klebsiella pneumoniae

See the list below:

  • Cefepime 2 g IV q8h or
  • Ceftazidime 2 g IV q8h or
  • Imipenem 500 mg IV q6h or
  • Meropenem 1 g IV q8h or
  • Piperacillin-tazobactam 4.5 g IV q6h

Extended-spectrum beta-lactamase (ESBL)–producingstrain

  • Imipenem 500 mg IV q6h or
  • Meropenem 1 g IV q8h

Carbapenem-resistant K pneumoniae (CRKP) strain

  • Colistin 5 mg/kg/day IV divided q12h or
  • Polymyxin B 15,000-25,000 units/kg/day IV divided q12h
  • Consider addition of meropenem 2 g IV q8h to colistin or polymyxin
  • Duration of therapy: 8-14 days

Methicillin-resistant Staphylococcus aureus (MRSA)

See the list below:

  • Linezolid 600mg IV or PO q12h for 7-10 days or
  • Vancomycin 15 mg/kg IV q12h for 7-10 days or
  • Telavancin 10mg/kg IV once daily for 7-21 days (reserved for use when alternative treatments are not suitable)

Methicillin-sensitive Staphylococcus aureus (MSSA)

See the list below:

  • Oxacillin 1g IV q4-6h for 7-14 days or
  • Nafcillin 1-2 g IV q6h for 7-14 days or
  • Cefazolin 2 g IV q8h for 7-10 days
  • Drugs listed for MRSA treatment may be used as alternatives if no beta-lactam drug is available

Legionella pneumophila

See the list below:

  • Levofloxacin 750 mg IV q24h, then 750 mg/day PO for 7-14 days or
  • Moxifloxacin 400 mg IV or PO q24h for 7-14 days or
  • Azithromycin 500 mg IV q24h for 7-10 days

Acinetobacter baumannii

See the list below:

  • Imipenem 1 g IV q6h or
  • Meropenem 2 g IV q8h (standard infusion or extended over 3 hours) or
  • Doripenem 500 mg IV q8h or
  • Ampicillin-sulbactam 3 g IV q6h or
  • Tigecycline 100 mg IV in a single dose, then 50 mg IV q12h or
  • Colistin 5 mg/kg/day IV divided q12h or
  • Polymyxin B 15,000-25,000 units/kg/day IV divided q12h
  • Duration of therapy: 14-21 days

Stenotrophomonas maltophilia

See the list below: