New guidelines for nosocomial pneumonia

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) remain important causes of morbidity and mortality in hospitalized patients. New evidence-based guidelines for the diagnosis and treatment of these entities were released by the Infectious Diseases Society of America and the American Thoracic Society in 2016. This review summarizes the recommendations contained within these guidelines and their supporting rationale.

With respect to diagnosis of HAP and VAP, the guidelines suggest using semiquantitative cultures of noninvasively obtained respiratory samples instead of quantitative cultures of invasively obtained samples. With respect to antibiotic treatment, the guidelines separate the treatment approach for VAP and HAP (non-VAP), and stress the importance of devising an appropriate empiric regimen based on an appropriate hospital or unit-specific antibiogram. For VAP, coverage of methicillin-resistant Staphylococcus aureus is recommended only when patients have specific risk factors for multidrug-resistant (MDR) pathogens or in units where greater than 10-20% of Staphylococcus aureus isolates are methicillin resistant. Single coverage for MDR gram-negative pathogens can be used in many HAP and VAP patients without risk factors for MDR pathogens when the antibiogram demonstrates that at least 90% of gram negatives are sensitive to the agent being considered for monotherapy. A 7-day course of antibiotics was recommended for most patients, including those with glucose nonfermenting gram-negative organisms.

New guidelines for the diagnosis and treatment of HAP and VAP contain several novel recommendations regarding the diagnosis and treatment of these entities.