Spectrum: Local Antimicrobial Stewardship, for Eastern Health

VAP diagnosis

VAP pathogen RFs

Diagnosis

Ventilation associated pneumonia is difficult to diagnose - consider the following features:

Clinical

Temperature <36 or >38, WBC <4 or >12, worsened oxygenation, purulent sputum, high bronchoalveolar lavage cellularity >400,000 cells/mL

Microbiologic

Microbiology generally not part of diagnosis due to delay to results. However, organism on gram stain and culture more suggestive than +ve culture only

Radiographic

New infiltrate on CXR, this has poor specificity due to poor film quality and the high prevalence of atelectasis

Note: Positive lower respiratory tract cultures do not equate to pneumonia - consider the whole clinical picture based on above features.

Collect Appropriate Cultures

Obtain blood cultures x2 and lower respiratory tract culture (endotracheal aspirate or bronchoscopic samples)

If significant pleural fluid on CXR or U/S – consider thoracentesis for sampling ± drainage

Collect cultures before antibiotics unless delay of >1h expected.