Management of Nosocomial Pneumonia

Document Type


Publication Date

Spring 2018




Despite improved management and prevention strategies, nosocomial pneumonia remains a cause of morbidity and mortality in critically ill patients; it is a leading cause of death among patients with hospital-acquired infections and a common source of sepsis.1 Critical care clinicians must recognize that most cases of hospital-acquired pneumonia (HAP) occur outside of the intensive care unit (ICU), so risk factors and empiric antibiotic choices need to be considered carefully, especially as patients are being transitioned to the ICU. Furthermore, an episode of ventilator-associated pneumonia (VAP) prolongs the need for mechanical ventilation, increases ICU and hospital lengths of stay, and costs almost $40 000.1–3

This article discusses current recommendations for the management of nosocomial pneumonia, based on the 2016 clinical practice guidelines developed by the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS).1 Definitions and appropriate therapy are presented, as are major treatment changes from the original 2005 guidelines.4 These changes include the removal of the term health care–associated pneumonia (HCAP), the use of antibiograms, the avoidance of aminoglycoside monotherapy and use of adjunctive inhaled antibiotic therapy, and a recommended treatment duration of 7 days for most patients.



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