VAP targeted Rx

Duration of Therapy

Treat for 8d for most pathogens but can stop sooner if clinical evidence of pneumonia resolved or alternate Dx made

Treat for 15d if MRSA, Pseudomonas, Acinetobacter or Stenotrophomonas recovered

Note

Use susceptibility data to guide therapy

Essentially all antibiotics have good lung penetration with the exception of daptomycin

Candida is a common colonizer of the respiratory tract of intubated patients and generally does NOT require therapy

Candida pneumonia is extremely rare, and occurs in the profoundly immunosuppressed as part of systemic candidiasis.

Radiographically, almost all cases manifest as nodular disease (microabscesses from hematogenous spread)

Suspect systemic candidiasis + pneumonia in patients with all of:

profound immunosuppression, nodular disease or a new infiltrate on chest imaging, sepsis, and candida in respiratory samples.

These patients require treatment for systemic candidiasis and Infectious Diseases consultation is recommended.

If colonized, consider adding coverage for resistant colonizer until culture data available