Ventilator - associated pneumonia (VAP)

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Empirical treatment of ventilator associated pneumonia (VAP) in adults
Definition Signs/ Symptoms Management
Initial Empirical Therapy Comment
Ventilator-associated pneumonia (VAP) is a type of HAP that developed in intubated patients on mechanical ventilation for more than 48 hours or within 48 hours after intubation. Fever > 38 C, purulent sputum , leukocytosis , leukopenia, hypoxemia , new lung infiltrate
NO MDR 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
MDR Risk Factors:
  • Receipt of IV antibiotics within past 90 days
  • Septic shock at the time of VAP
  • ARDS preceding VAP
  • ≥ 5 days of hospitalization prior to the occurrence of VAP
  • Acute renal replacement therapy prior to VAP
History of colonization with MDR in any body site or > 10 % resistance to Piper/Tazo and Cefepime or Local prevalence of susceptibility is unknown:

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 isolate in HAP are MRSA
  • Prevalence of MRSA is unknown
  • Colonization of MRSA on culture from any body site
MDR and MRSA Risk Factors:

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
Duration: We suggest treatment of VAP 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