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. 2008 Jan;19(1):19-53.
doi: 10.1155/2008/593289.

Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults

Coleman Rotstein  1 , Gerald Evans, Abraham Born, Ronald Grossman, R Bruce Light, Sheldon Magder, Barrie McTaggart, Karl Weiss, George G Zhanel
Affiliations

Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults

Coleman Rotstein et al. Can J Infect Dis Med Microbiol. 2008 Jan.

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Can J Infect Dis Med Microbiol. 2008 Nov;19(6):438. Can J Infect Dis Med Microbiol. 2008. PMID: 19436576 Free PMC article.

Abstract
in English, French

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are important causes of morbidity and mortality, with mortality rates approaching 62%. HAP and VAP are the second most common cause of nosocomial infection overall, but are the most common cause documented in the intensive care unit setting. In addition, HAP and VAP produce the highest mortality associated with nosocomial infection. As a result, evidence-based guidelines were prepared detailing the epidemiology, microbial etiology, risk factors and clinical manifestations of HAP and VAP. Furthermore, an approach based on the available data, expert opinion and current practice for the provision of care within the Canadian health care system was used to determine risk stratification schemas to enable appropriate diagnosis, antimicrobial management and nonantimicrobial management of HAP and VAP. Finally, prevention and risk-reduction strategies to reduce the risk of acquiring these infections were collated. Future initiatives to enhance more rapid diagnosis and to effect better treatment for resistant pathogens are necessary to reduce morbidity and improve survival.

La pneumonie nosocomiale (PN) et la pneumonie sous ventilation assistée (PVA) sont d’importantes causes de morbidité et de mortalité, les taux de mortalité avoisinant les 62 %. Dans l’ensemble, la PN et la PVA constituent la deuxième cause d’infection nosocomiale en importance, mais la principale cause documentée à l’unité de soins intensifs. De plus, la PN et la PVA produisent le plus fort taux de mortalité imputable à une infection nosocomiale. C’est pourquoi on a préparé des lignes directrices probantes détaillant l’épidémiologie, l’étiologie microbienne, les facteurs de risque et les manifestations cliniques de la PN et de la PVA. De plus, une démarche axée sur les données disponibles, l’opinion d’experts et les pratiques courantes de prestation des soins au sein du système de santé canadien ont permis de déterminer les schèmes de stratification des risques afin de favoriser un diagnostic pertinent, la prise en charge antimicrobienne et la prise en charge non antimicrobienne de la PN et de la PVA. Enfin, on a colligé des stratégies de prévention et de réduction des risques afin de réduire le risque d’acquérir ces infections. De futures initiatives en vue de favoriser un diagnostic plus rapide et d’assurer le meilleur traitement des pathogènes résistants s’imposent pour réduire la morbidité et accroître le taux de survie.

Keywords: Guidelines; Hospital-acquired; Pneumonia; Ventilator-associated.

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Figures

Figure 1
Figure 1
Breakdown of hospital-acquired pneumonia/intensive care unit (HAP/ICU) and HAP/ventilator-associated pneumonia (VAP). Information taken from references ,,,
Figure 2
Figure 2
Endogenous and exogenous sources of microorganisms causing hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). Adapted from references ,
Figure 3
Figure 3
Algorithm for determining the microbiological cause of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) using risk factors for resistance and severity of illness. MRSA Methicillin-resistant Staphylococcus aureus; MSSA Methicillin-sensitive S aureus. Data are from references ,,,–, and represent level A-2 data
Figure 4
Figure 4
The pathogenesis of hospital-acquired pneumonia and ventilator-associated pneumonia. Adapted from reference
Figure 5
Figure 5
Diagnostic algorithm for hospital-acquired pneumonia and ventilator-associated pneumonia. Please note that there is no definitive scientific evidence or expert consensus that quantitative testing produces better clinical outcomes than empirical treatment. Scientific evidence of improved specificity, supplemented by expert opinion, supports the performance of invasive tests to avoid the use of antibiotics for clinically insignificant organisms, but there is no direct evidence or consensus regarding the superiority of one invasive test over another. Factors to consider in choosing an appropriate test include sensitivity and specificity, ability to improve patient outcome, potential adverse effects, test availability and cost. CPIS Clinical pulmonary infection score; ICU Intensive care unit; PaO2 Partial pressure of oxygen in arterial blood
Figure 6
Figure 6
Treatment algorithm for hospital-acquired pneumona. BID Twice daily; ICU Intensive care unit; IV Intravenous; MRSA Methicillin-resistant Staphylococcus aureus; MSSA Methicillin-susceptible S aureus; q Every; po By mouth
Figure 7
Figure 7
Treatment algorithm for ventilator-associated pneumonia (VAP). d Day; IV Intravenous; MRSA Methicillin-resistant Staphylococcus aureus; MSSA Methicillin-sensitive S aureus; q Every
See this image and copyright information in PMC

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