Spectrum: Local Antimicrobial Stewardship, for Bakersfield Memorial Hospital

VAP

Notes

Our hospital's MRSA prevalence of S. aureas isolates is >10-20%, so MRSA coverage should be included

Double cover for P. aeruginosa if patient has any of:

  • ARDS prior to VAP

  • Septic Shock at time of VAP

  • IV antibiotics within 90 days

  • Acute renal replacement prior to VAP

  • 5 days or more in hospital prior to VAP

  • Structural lung disease

  • There is an abundance of GNB on gram stain

Monotherapy for P. aeruginosa is recommended once microbiology data is known

Empiric Therapy

Cefepime 2 g IV every 8 hr

OR

Zosyn 3.375 g IV ever 8 hr (4 hr infusion)

PLUS

Vancomycin

CONSIDER ADDING

Tobramycin IV 5mg/kg/day⁽¹⁾

⁽¹⁾ If double coverage for P. aeruginosa is recommended

OR

Levofloxacin 750 mg IV every 24 hr⁽¹⁾⁽²⁾

⁽¹⁾ If double coverage for P. aeruginosa is recommended
⁽²⁾ If Legionella suspected.

Cephalosporin Allergy

Aztreonam 2 g IV every 8 hr

Duration of Therapy

7 days is recommended versus a longer course, independent of microbial etiology.