Answer 18: Optimal management of HAP, VAP, and HCAP

20 June, 2018

 

 

First, clinicians should be able to identify patients at risk for infection with MDR bacteria including MRSA, Acinetobacter species, and Pseudomonas aeruginosa. Second, they should be aware of the local susceptibilities of these pathogens to available antimicrobial agents and prescribe an initial regimen that will provide appropriate initial therapy to patients infected with MDR bacteria. Third, antimicrobial de-escalation should be practiced. This means that the spectrum and number of antibiotics is narrowed or modified based on the identified pathogens and their drug susceptibilities. Finally, the antibiotic regimen should be continued for the shortest time clinically indicated. For most uncomplicated cases of HAP, VAP, and HCAP this means a 7- or 8-day course. The one exception may be Pseudomonas aeruginosa where a longer course of therapy may prevent infection recurrences.