HCAP is out - New IDSA Guidelines for HAP and VAP

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Short Attention Span Summary

Save yourself some time.  Read this, not 51 pages.
The IDSA released new guidelines for treatment of ventilator associated pneumonia (VAP) and hospital acquired pneumonia (HAP) in July.  Healthcare-associated pneumonia (HCAP) has been done away with, as there was a lower risk for multi-drug resistant pathogens than expected in the HCAP population.  Here is the gist of this 51 page document.

  • Invasive cultures aren't needed.
  • Biomarkers are out, like procalcitonin and CRP.
  • Empiric treatment should be guided by local hospital resistance patterns.
  • VAP should include MRSA coverage if >10% methicillin resistance rate and should only double cover for gram-negatives, i.e. pseudomonas, if at risk for multi-drug resistant organism or >10% gram-negative resistance rates.
From the article

From the article

  • Here are the recommended regimens for VAP
From cited article

From cited article

  • Here are the recommendations for HAP.
From cited article

From cited article

  • Treatment should be for 7 days, not 15.
  • There are several other recommendations regarding dosing and specific pathogens that are not as directly applicable to the ED.

Spoon Feed
HCAP is out. HAP and VAP remain. Empiric treatment has been streamlined.  Use a resource like Evidence Care, which has these latest guidelines included, to help you properly categorize and treat these patients.

 

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Abstract

Clin Infect Dis. 2016 Sep 1;63(5):e61-e111. doi: 10.1093/cid/ciw353. Epub 2016 Jul 14.

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.

Kalil AC1, Metersky ML2, Klompas M3, Muscedere J4, Sweeney DA5, Palmer LB6, Napolitano LM7, O'Grady NP8, Bartlett JG9, Carratalà J10, El Solh AA11, Ewig S12, Fey PD13, File TM Jr14, Restrepo MI15, Roberts JA16, Waterer GW17, Cruse P18, Knight SL18, Brozek JL19.

Author information:

1Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha.

2Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington.

3Brigham and Women's Hospital and Harvard Medical School Harvard Pilgrim Health Care Institute, Boston, Massachusetts.

4Department of Medicine, Critical Care Program, Queens University, Kingston, Ontario, Canada.

5Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego.

6Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, State University of New York at Stony Brook.

7Department of Surgery, Division of Trauma, Critical Care and Emergency Surgery, University of Michigan, Ann Arbor.

8Department of Critical Care Medicine, National Institutes of Health, Bethesda.

9Johns Hopkins University School of Medicine, Baltimore, Maryland.

10Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Spanish Network for Research in Infectious Diseases, University of Barcelona, Spain.

11Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, Veterans Affairs Western New York Healthcare System, New York.

12Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt Bochum, Germany.

13Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha.

14Summa Health System, Akron, Ohio.

15Department of Medicine, Division of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System and University of Texas Health Science Center at San Antonio.

16Burns, Trauma and Critical Care Research Centre, The University of Queensland Royal Brisbane and Women's Hospital, Queensland.

17School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.

18Library and Knowledge Services, National Jewish Health, Denver, Colorado.

19Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Abstract

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.

© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

PMCID: PMC4981759 [Available on 2017-09-01]

PMID: 27418577 [PubMed - in process]