Hospital-Acquired Pneumonia, Health Care-Associated Pneumonia, and Ventilator-Associated Event Empiric Therapy 

Updated: Aug 31, 2017
  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Thomas E Herchline, MD  more...
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Empiric Therapy Regimens

Empiric therapeutic regimens for hospital-acquired pneumonia (HAP), health care–associated pneumonia (HCAP), and ventilator-associated event (formerly known as ventilator-associated pneumonia [VAP]) are outlined below, including those for early onset, late onset, and multidrug-resistant (MDR) factors. [1, 2, 3, 4]

Definitions

Definitions of HAP, VAE, and HCAP are as follows:

  • HAP: Diagnosis made more than 48 hours after admission and did not appear to be incubating at the time of admission
  • VAE: 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 three months preceding 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

Hospital-acquired pneumonia or ventilator-associated event

Regimens for early onset (<5 days since admission) and no MDR risk factors are as follows:

Regimens for late onset (≥5 days since admission), MDR risk factors present, or diagnosis of HCAP are as follows:

PLUS

PLUS

Duration of therapy:

  • If clinical improvement is noted in 48-72 hours and cultures are negative, consider stopping antibiotics
  • If clinical improvement is noted in 48-72 hours and cultures are positive, adjust regimen per susceptibilities and continue antibiotics for 7-8 days
  • If there is no clinical improvement and cultures are negative, look for alternative diagnoses
  • If there is no clinical improvement and cultures are positive, adjust regimen per susceptibilities