HCAP/VAP/Nosocomial

Risk factors for MDR pathogens:

• Antimicrobial therapy in proceeding 90 d
• Current hospitalization of 5 days or more
• High frequency of antibiotic resistance in the community or in the specific hospital unit
• Risk factors for HCAP:
  
• -Hospitalization for 2 days or more in the preceding 90 d
• -Residence in a NH or extended care facility
  
• -Chronic dialysis within 30 d
• -Home wound care
• -Family member with MDR pathogen
  
• Immunosuppressive disease and/or therapy

HCAP can be missed as a CAP. Good medical questionnaire will reveal prior admits, prior multiple antibiotics use, home wound care, family member with MDR pathogen.

Empirical therapy:

If no risk factors for MDR pathogens: (early nosocomial or ventilator associated pneumonia)

• Ceftriaxone
  
• Levofloxacin, Moxifloxacin
  
• Ampicillin/sulbactam
  
• Ertapenem
  

If risk factrors for MDR pathogens exist:

• Anti-pseudomonal cephalosporin or Carbapenem or beta-lactam/linhibitor
  
• (Cefepime, ceftazidime) (Imi/mero/Doripenem) (piperacillin/tazobactam)
  

PLUS

• Antipseudomonal quinolone or Aminoglycoside
  
• (Levofloxacin, Ciprofloxacin) (Amikacin,Gentamycin, Tobramycin)
  

PLUS

• Linezolid or Vancomycin

Table of apropriate dosages in MDR pathogens

Reference: IDSA guidelines