VAP

Sputum cultures should be obtained prior to starting or changing antibiotics by endotracheal suction or invasive techniques such as BAL. ET suction appears just as sensitive but less specific than invasive methods.

Empiric treatment MUST be narrowed as soon as sputum culture results are known.

Vancomycin can be STOPPED if no resistant Gram-positive organisms are identified.

If the patient is on antibiotic therapy or has recently been on antibiotic therapy, choose an agent from a different class.

ATS/IDSA Guidelines for HAP/HAV: AJRCCM 2005;171:388.

Clinical response to VAP: AJRCCM 2001;163:1371-1375.

VAP: Arch Intern Med 2000;160: 1926-6.

 Mini-BAL: Chest 1998;113:412-20.

CPIS score: Am Rev Respir Dis 1991;143:1121–1129.

 Determining course of therapy using CPIS Score: Am J Respir Crit Care Med 2000; 162: 505

Intensive Care Med 2004; 30: 735–738.