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Current Opinion in Pulmonary Medicine
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New guidelines for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) recommend semiquantitative cultures for diagnosis and tailored antibiotic treatment. These evidence-based strategies aim to improve patient outcomes for HAP and VAP.

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Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Pulmonology

Background:

  • Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are significant causes of illness and death in hospitalized patients.
  • Updated evidence-based guidelines for HAP and VAP diagnosis and treatment were published in 2016.

Purpose of the Study:

  • To review the 2016 Infectious Diseases Society of America and American Thoracic Society guidelines for HAP and VAP.
  • To summarize the recommendations and rationale for diagnosing and treating HAP and VAP.

Main Methods:

  • Review of evidence-based guidelines from the Infectious Diseases Society of America and American Thoracic Society.
  • Summary of diagnostic and therapeutic recommendations for HAP and VAP.

Main Results:

  • Guidelines recommend semiquantitative cultures of noninvasive respiratory samples over quantitative cultures of invasive samples for HAP/VAP diagnosis.
  • Antibiotic treatment strategies differentiate HAP (non-VAP) and VAP, emphasizing hospital-specific antibiograms for empiric regimens.
  • Methicillin-resistant Staphylococcus aureus (MRSA) coverage for VAP is reserved for patients with specific risk factors or high MRSA prevalence.
  • Monotherapy for multidrug-resistant (MDR) gram-negative pathogens is permissible for HAP/VAP patients without MDR risk factors if local antibiograms show >90% sensitivity.
  • A 7-day antibiotic course is recommended for most HAP/VAP patients, including those with glucose nonfermenting gram-negative organisms.

Conclusions:

  • The 2016 guidelines introduce novel recommendations for HAP and VAP diagnosis and treatment.
  • Adherence to these updated guidelines can potentially optimize management and improve outcomes for patients with HAP and VAP.