Key Points
- Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) continue to be frequent complications of hospital care. Together, they are among the most common hospital-acquired infections (HAIs), accounting for 22% of all HAIs in a multistate point-prevalence survey.
- All-cause mortality associated with VAP has been reported to range from 20%–50%.
- Serious complications from HAP occur in approximately 50% of patients.
Diagnosis
Table 1. Risk Factors for Multidrug-Resistant Pathogens
Risk factors for MDR VAP
- Prior intravenous antibiotic use within 90 d
- Septic shock at time of VAP
- Acute respiratory distress syndrome (ARDS) preceding VAP
- ≥5 days of hospitalization prior to the occurrence of VAP
- Acute renal replacement therapy prior to VAP onset
Risk factors for MDR HAP
- Prior intravenous antibiotic use within 90 d
Risk factors for MRSA VAP/HAP
- Prior intravenous antibiotic use within 90 d
Risk factors for MDR Pseudomonas VAP/HAP
- Prior intravenous antibiotic use within 90 d
Microbiologic Methods
- ATS and IDSA suggest noninvasive sampling with semiquantitative cultures to diagnose VAP, rather than invasive sampling with quantitative cultures and rather than noninvasive sampling with quantitative cultures (W-L).
- Noninvasive sampling with semiquantitative cultures is the preferred methodology to diagnose VAP. However, the panel recognizes that invasive quantitative cultures will occasionally be performed by some clinicians. For patients with suspected VAP whose invasive quantitative culture results are below the diagnostic threshold for VAP, ATS and IDSA suggest that antibiotics be withheld rather than continued (W-VL).
- ATS and IDSA suggest that patients with suspected HAP (non-VAP) be treated according to the results of microbiologic studies performed on respiratory samples obtained noninvasively, rather than being treated empirically (W-VL).
Biomarkers
- For patients with suspected HAP/VAP, ATS and IDSA recommend using clinical criteria alone, rather than using serum procalcitonin plus clinical criteria, to decide whether or not to initiate antibiotic therapy (S-M).
- For patients with suspected HAP/VAP, ATS and IDSA recommend using clinical criteria alone, rather than using bronchoalveolar fluid sTREM-1 plus clinical criteria, to decide whether or not to initiate antibiotic therapy (S-M).
- For patients with suspected HAP/VAP, ATS and IDSA recommend using clinical criteria alone rather than using C-Reactive Protein (CRP) plus clinical criteria, to decide whether or not to initiate antibiotic therapy (W-L).
- For patients with suspected HAP/VAP, ATS and IDSA suggest using clinical criteria alone, rather than using Modified Clinical Pulmonary Infection Score (CPIS) plus clinical criteria, to decide whether or not to initiate antibiotic therapy (W-L).
S, strong; W, weak strength of recommendation
H, high; M, moderate; L, low; VL, very low quality of evidence
