Hospital-acquired pneumonia diagnostic algorithm

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Diagnostic Algorithm

Shown below is an algorithm for the diagnostic approach of Healthcare-associated pneumonia (HCAP), Ventilator-associated pneumonia VAP), and Hospital-acquired pneumonia (HAP).

High suspicion of HAP, VAP or HCAP

Obtain sputum or respiratory secretions sample for culture and microscopy

Does the patient has any of the following risk factors for MDR infection? Antimicrobial therapy in preceding 90 days Current hospitalization of ≥ 5 days High frequency of antibiotic resistance in the community or in the specific hospital unit Immunosuppressive disease and/or therapy Presence of risk factors for HCAP: Hospitalization ≥2 days in the preceding 90 days Residence in a nursing home or extended care facility Home infusion therapy (including antibiotics) Chronic dialysis within 30 days Home wound care Family member with multidrug-resistant pathogen

Yes Start empirical therapy with combined broad spectrum antibiotics Click here for more detail

No Start empirical therapy with limited spectrum antibiotics Click here for more detail

After 2-3 days, check cultures and assess the clinical response based on: Temperature WBC count Chest X-ray Oxygenation Sputum production Hemodynamic status

Does the patient improved his clinical status after 48-72 hours?

Yes Assess culture results

No Assess culture results

Positive Culture

Negative Culture

Positive Culture

Negative Culture

De-escalate antibiotics, treat for 7-8 more days and re-evaluate

Consider stopping antibiotics

Adjust antibiotic regimen based on culture susceptibility, look for other infection sites and complications

Look for other pathogens, infection sites and complications