American Thoracic Society Quick-Reference GUIDELINES Apps
Issue link: https://eguideline.guidelinecentral.com/i/769839
4 Treatment Initial Î In patients with ventilator-associated tracheobronchitis (VAT) ATS and IDSA suggest NOT providing antibiotic therapy (W-L). Î ATS and IDSA recommend that all hospitals regularly generate and disseminate a local antibiogram, ideally one that is specific to their intensive care population(s) if possible. Î ATS and IDSA recommend that empiric treatment regimens be informed by the local distribution of pathogens associated with VAP and their antimicrobial susceptibilities. Î In patients with suspected VAP, ATS and IDSA recommend including coverage for S. aureus, Pseudomonas aeruginosa, and other Gram- negative bacilli in all empiric regimens (S-L). • ATS and IDSA suggest including an agent active against MRSA for the empiric treatment of suspected VAP only in patients with any of the following : a risk factor for antimicrobial resistance (Table 3), patients being treated in units where 10%–20% of S. aureus isolates are methicillin resistant, and patients in units where the prevalence of MRSA is not known (W-VL). • ATS and IDSA suggest including an agent active against methicillin-sensitive S. aureus (MSSA) (and not MRSA) for the empiric treatment of suspected VAP in patients without risk factors for antimicrobial resistance, who are being treated in intensive care units (ICUs) where <10%–20% of S. aureus isolates are methicillin resistant (W-VL). Î If empiric coverage for MRSA is indicated, ATS and IDSA recommend either vancomycin or linezolid (S-M). Î When empiric treatment that includes coverage for MSSA (and not MRSA) is indicated, ATS and IDSA suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem (W-VL). • Oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven MSSA but are not necessary for the empiric treatment of VAP if one of the above agents is used. Î ATS and IDSA suggest prescribing two antipseudomonal antibiotics from different classes for the empiric treatment of suspected VAP only in patients with any of the following: a risk factor for antimicrobial resistance (Table 3), patients in units where >10% of Gram-negative isolates are resistant to an agent being considered for monotherapy, and patients in an ICU where local antimicrobial susceptibility rates are not available (W-L). Î ATS and IDSA suggest prescribing one antibiotic active against P. aeruginosa for the empiric treatment of suspected VAP in patients without risk factors for antimicrobial resistance who are being treated in ICUs where <10% of Gram-negative isolates are resistant to the agent being considered for monotherapy (W-L).