Definition
Hospital-acquired Pneumonia (HAP)
- Defined as pneumonia occurring ≥48 hours after admission and excluding any infection that is incubating at the time of admission
- Described as pneumonia occurring >48-72 hours after endotracheal intubation and within 48 hours after removal of endotracheal (ET) tube
Signs and Symptoms
Typical Signs and Symptoms
- Fever
- Cough with or without sputum production
- Purulent sputum
- Dyspnea, shortness of breath (SOB)
- Respiratory failure
- Worsening oxygenation
- Increased heart rate
- Increased minute ventilation
Risk Factors
- Multidrug-resistant (MDR) is defined as an acquired non-susceptibility to at least one agent in three different antimicrobial classes
- Extensively drug resistant (XDR) refers to non-susceptibility to at least one agent in all but two antimicrobial classes
- Pandrug resistant (PDR) refers to non-susceptibility to all antimicrobial agents that can be used for treatment
Risk Factors for Hospital-acquired Pneumonia (HAP)/Ventilator-Acquired Pneumonia (VAP)
- Patient-related: Age, chronic pulmonary disease, multiple organ system failure, depressed consciousness
- Treatment-related: Intubation/mechanical ventilation, reintubation, prolonged intubation, previous exposure to antibiotics, thoracoabdominal surgery
- Triggers of aspiration: Positioning, nasogastric tube insertion, enteral feeding, low endotracheal tube pressure
- Oropharyngeal colonization
- ≥5 days duration stay for the current hospitalization prior to occurrence of VAP
- Septic shock at the time of VAP/HAP
- Acute respiratory distress syndrome preceding VAP
- Acute renal replacement therapy before VAP onset
- IV antibiotics within the preceding 90 days
- Risk factor for MDR, Methicillin-resistant Staphylococcus aureus (MRSA), and MDR Pseudomonas VAP and HAP
- Intensive care unit (ICU) admission
- Structural lung disease (eg bronchiectasis, cystic fibrosis) for HAP
- Colonization with or prior isolation of MDR Pseudomonas or other Gram-negative bacilli