Hospital-acquired Pneumonia & Ventilator-associated Pneumonia (Adults) Clinical Guideline
Version 2.0 approved 27 February 2023
The Hospital-acquired Pneumonia & Ventilator-associated Pneumonia (Adults) Clinical Guideline (PDF 337KB) has been developed by the South Australian expert Advisory Group on Antimicrobial Resistance (SAAGAR) to guide the management of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in immunocompetent patients. This guideline should not be used for the management of patients with pneumonia acquired in healthcare facilities such as aged-care facilities, haemodialysis centres, outpatient clinics, or for those hospitalised for more than 48 hours within the past three months (previously referred to as healthcare-associated pneumonia (HCAP)). Based on current available evidence, patients who would have previously been diagnosed with HCAP, are considered at low risk of harbouring multidrug-resistant (MDR) organisms [1, 2], and the majority of these patients can be managed as per the state-wide guideline for Community Acquired Pneumonia in adults.
Key stewardship points
- HAP is defined as a pneumonia occurring ≥ 48 hours after hospital admission that was NOT incubating at the time of admission
- For pneumonia occurring < 48 hours after hospital admission, refer to the state-wide guideline for Community Acquired Pneumonia in adults (PDF 852KB)
- Review clinical radiologic and microbiological factors, and consider alternate diagnosis (e.g., atelectasis, heart failure, aspiration pneumonitis) prior to commencing the broad-spectrum antibiotics included in this guideline
- Assess severity of disease before commencing the recommended treatment for HAP
- Review therapy after 24-48 hours; cease antibiotics if an alternate diagnosis is made OR consider narrowing the spectrum of antibiotics if appropriate, based on microscopy, culture, and sensitivity
- Most cases of HAP and VAP can be treated effectively with 5-7 days of antimicrobial therapy