With multidrug-resistant (MDR) pathogens increasing and a dwindling pipeline of new antibiotics to treat these pathogens, sensible use of antibiotics is needed. ED clinicians have an opportunity to optimize treatment for patients with pneumonia who are at risk for MDR pathogens.
Recently, the Infectious Diseases Society of America (IDSA) published a much-needed update to the Hospital Acquired Pneumonia / Ventilator Associated Pneumonia (HAP/VAP) guidelines. While the Infectious Diseases Society of America (IDSA) guidelines recognize that there are no standardized definitions for HAP and VAP, they are loosely defined.
HAP is characterized as pneumonia not incubated at the time of hospital admission and occurring 48 hours or more after admission, while VAP is pneumonia occurring >48 hours after endotracheal intubation.
Using these interpretations, HAP and VAP are not commonly seen in the ED; however, treatment and risk factors are similar to patients commonly presenting with pneumonia. Both HAP and VAP patients have similar outcomes and infectious pathogens, and therefore receive comparable empiric antibiotics. VAP will not be discussed due to the low likelihood of encounters in the ED.
- Identify common organisms that cause hospital-acquired pneumonia (HAP)
- Explain why healthcare-associated pneumonia (HCAP) was removed from the 2016 IDSA guidelines
- Recognize risk factors for multidrug-resistant organisms for HAP
- Describe antibiotic treatment options for HAP in the ED
|Jamie M. Rosini, PharmD, MS, BCPS, BCCCP, DABAT||Clinical Pharmacy Specialist, Emergency Medicine; Christiana Care Health System||@jrozzini|
|Matthew Stanton, PharmD, BCPS, SPI, DABAT||Emergency Medicine Pharmacist; Froedtert & The Medical College of Wisconsin||@RxMilwaukee|
|Chris Edwards, PharmD, BCPS||Emergency Medicine Pharmacist, University of Arizona Medical Center|
|Craig Cocchio, MD BCPS||Emergency Medicine Pharmacist, Trinity Mother Frances Hospital||@iEMPharmD|
|Cole Sloan, PharmD||Emergency Medicine Pharmacist, University of Utah||@|
|Michael Winters, MD FAAEM, FACEP||Associate Professor of Emergency Medicine and Internal Medicine, University of Maryland||@critcareguys|
Meghan Groth, PharmD, BCPS
|University of Massachusetts Memorial Medical Center||@EMPharmgirl|
||Emergency Medicine Pharmacist, Robert Wood Johnson University Hospital||@nadia_empharmd|
Bryan Hayes, PharmD FAACT
|Emergency Medicine Pharmacist, Massachusetts General Hospital||@PharmERToxGuy|