HAP and VAP

Definitions

Hospital-acquired pneumonia (HAP) is defined as a pneumonia not incubating at the time of hospital admission and occurring 48 hours or more after admission.

Ventilator-associated pneumonia (VAP) is defined as a pneumonia occurring greater than 48 hours after endotracheal intubation.

Common Pathogens

Gram negative bacilli

  •  Klebsiella

  •  Pseudomonas aeruginosa

  •  etc

Risk Factors

  • Prior IV antibiotic use within 90 days
  • Ventilatory support for HAP
  • Septic shock
  • Acute respiratory distress syndrome preceding VAP
  • Five or more days of hospitalization prior to the occurrence of VAP
  • Acute renal replacement therapy prior to VAP onset

  • Prior IV antibiotic use within 90 days
  • High risk for mortality (need for ventilatory support due to pneumonia and septic shock)
  • Structural lung disease (i.e. bronchiectasis, cystic fibrosis, COPD)
  • Prior infection with Pseudomonas

  • Prior IV antibiotic use within 90 days
  • Unit has greater than 20% of S. aureus isolates that are methicillin resistant
  • High risk for mortality (need for ventilatory support due to pneumonia and septic shock)
  • Known colonization with MRSA