Hospital Acquired Pneumonia

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.

Learning Objectives

  1. Identify common organisms that cause hospital-acquired pneumonia (HAP)
  2. Explain why healthcare-associated pneumonia (HCAP) was removed from the 2016 IDSA guidelines
  3. Recognize risk factors for multidrug-resistant organisms for HAP
  4. Describe antibiotic treatment options for HAP in the ED

Course Contributors

Authors  Affiliation Twitter
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
Reviewers  Affiliation Twitter
Chris Edwards, PharmD, BCPS Emergency Medicine Pharmacist, University of Arizona Medical Center @emergencypharm
Craig Cocchio, MD BCPS Emergency Medicine Pharmacist, Trinity Mother Frances Hospital @iEMPharmD
Cole Sloan, PharmD Emergency Medicine Pharmacist, University of Utah @DrugInfoGeek
Michael Winters, MD FAAEM, FACEP Associate Professor of Emergency Medicine and Internal Medicine, University of Maryland @critcareguys
Editors  Affiliation Twitter
Copy Editor:
Meghan Groth, PharmD, BCPS
University of Massachusetts Memorial Medical Center @EMPharmgirl
Associate Editor:
Nadia Awad, PharmD BCPS
Emergency Medicine Pharmacist, Robert Wood Johnson University Hospital @nadia_empharmd
Lead Editor:
Bryan Hayes, PharmD FAACT
Emergency Medicine Pharmacist, Massachusetts General Hospital @PharmERToxGuy