Hospital- associated pneumonia (HAP)

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Empirical treatment of hospital -associated pneumonia (HAP) in adults
Definition Signs/ Symptoms Management
Initial Empirical Therapy Comment
Hospital- aquired (or nosocomial ) pneumonia (HAP) is pneumonia that accurs 48 hours or more after admission to hospital and not appear to be intubated at the time of admission. Fever > 38 C, purulent sputum , leukocytosis , leukopenia, hypoxemia , new lung infiltrate
Patient with NO MDR/Mortality risk factors:

Select one of the following antibiotics:

  • Cefepime 2 g IV every 8 hours
  • Piperacillin/Tazo 4.5 g IV every 6 hours
* Add Anti-MRSA if any MRSA risk factors
Risk factors for mortality or MDR Pathogens:
  • Need for ventilatory support due to pneumonia
  • Septic shock
  • Receipt of IV antibiotics within past 90 days
History of colonization with MDR in any body site:

Select one of the following antibiotics:

  • Meropenem 1 g IV every 8 hours
  • Imipenem/Cil 500 mg IV every 6 hours
* Add Anti-MRSA if any MRSA risk factors
Risk Factors for MRSA:
  • > 10 to 20% of S.aureus isolates in HAP are MRSA
  • Prevalence of MRSA is unknown
  • Colonization of MRSA on culture from any body site
Patient with risk factors for mortality or MDR Pathogens:

Select one of the following antibiotics:

  • Meropenem 1 g IV every 8 hours
  • Imipenem/Cil 500 mg IV every 6 hours

Plus:

Select one of the following:

  • Vancomycin 15 - 20 mg/kg/dose IV every 8 to 12 hours
  • Linezolid 600 mg IV every 12 hours
 Prolonged infusion of β-lactams is preferred
Duration: We suggest treatment of HAP for seven days
References:

ATS/IDSA 2016 Clinical Practice Guidelines for the Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia, last update 2018