How is hospital-acquired pneumonia (HAP) treated?

Updated: Jul 30, 2018
  • Author: Burke A Cunha, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Answer

Answer

MSSA should be covered unless the patient has risk factors for MRSA, including intravenous antibiotic use within the preceding 90 days, exposure to a hospital unit where more than 20% of S aureus isolates are MRSA, or a high risk of death (eg, need for ventilatory support due to septic shock). Vancomycin or linezolid should be used to empirically cover MRSA.

For empiric coverage of MSSA, piperacillin-tazobactam cefepime, levofloxacin, imipenem, or meropenem is preferred. In cases of proven MSSA infection, oxacillin, nafcillin, or cefazolin is favored.

Double coverage against P aeruginosa should be provided in the empiric treatment of individuals with HAP who are likely to have Pseudomonas and other gram-negative infections or who are at a high risk of mortality (need for ventilatory support and/or septic shock). For all other cases, single coverage of P aeruginosa is indicated. [11]


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