HAP vs VAP treatment: a flowchart

One discussion this week involved treatment for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP).

Reference: Kenny JES. IDSA Guidelines 2016: HAP, VAP & It’s the End of HCAP as We Know It (And I Feel Fine) [website]. 2016 Jul 30. Retrieved from https://pulmccm.org/infectious-disease-sepsis-review/idsa-guidelines-2016-hap-vap-end-hcap-know-feel-fine/

Summary: “While the current [IDSA 2016] guidelines discuss a number of issues germane to HAP and VAP including: microbiological evaluation, ventilator-associated tracheobronchitis, the use of biomarkers and clinical prediction scores, inhaled antibiotics, etc. this post will focus on standard, empiric therapy as this is a common clinical quandary [see figure 1]” (Kenny 2016).

hap vap

“The current guidelines recommend 7 days of antimicrobial therapy for both HAP and VAP.  The authors conducted their own meta-analysis and found no difference in mortality or recurrence between long and short-courses of therapy.  This is incongruent with an often referenced trial in 2003 which noted a higher pneumonia recurrence rate if non-fermenting gram negative bacilli [e.g. pseudomonas] were isolated and patients were treated with 8 days versus 15 days of anti-microbials” (Kenny 2016).

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