pulmonary disorders
Ventilator Associated Pneumonia
Treatment of Ventilator Associated Pneumonia
Empirically chosen antibiotics active against resistant organisms If ventilator-associated pneumonia is suspected, treatment is with antibiotics that are chosen empirically based on Local sensitivity patterns Patient risk factors for antibiotic-resistant pathogens . The current, 2016 recommendations ( Treatment reference ) emphasize use of a narrower spectrum of empiric antibiotics when possible. Empiric therapy for VAP without Piperacillin/tazobactam Cefepime Levoﬂoxacin Imipenem Meropenem Doses depend on renal function (see table Usual Dosages of Commonly Prescribed Antibiotics[a] ). In treatment settings where MRSA rates are > 10% to 20%,vancomycinorlinezolidshould be added. In patients who are at high risk for mortality or who have risk factors for antibiotic-resistant organisms, or in the absence of reliable local antibiograms, recommendations include triple therapy using 2 drugs with activity againstPseudomonasand 1 drug with activity against MRSA: An antipseudomonal cephalosporin (cefepimeorceftazidime)oran antipseudomonal carbapenem (imipenem,meropenem)ora beta-lactam/beta-lactamase inhibitor (piperacillin/tazobactam) An antipseudomonal fluoroquinolone (ciprofloxacinorlevofloxacin)oran aminoglycoside (amikacin,gentamicin,tobramycin) Linezolidorvancomycin While indiscriminate use of antibiotics is a major contributor to development of antimicrobial resistance, adequacy of initial empiric antibiotics is a major determinant of a favorable outcome. Therefore, treatment must begin with initial use of broad-spectrum drugs, which are then changed to the narrowest regimen possible based on clinical response and the results of cultures and antibiotic susceptibility testing. 1.Kalil AC, Metersky ML, Klompas M, et al: Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society.Clin Infect Dis63(5):e61–111, 2016. 