American Thoracic Society Quick-Reference GUIDELINES Apps
Issue link: https://eguideline.guidelinecentral.com/i/769839
5 Î In patients with suspected VAP, ATS and IDSA suggest avoiding aminoglycosides if alternative agents with adequate Gram-negative activity are available (W-L). ÎIn patients with suspected VAP, ATS and IDSA suggest avoiding colistin if alternative agents with adequate Gram-negative activity are available (W-VL). Î ATS and IDSA recommend that all hospitals regularly generate and disseminate a local antibiogram, ideally one that is tailored to their HAP population, if possible. Î ATS and IDSA recommend that empiric antibiotic regimens be based upon the local distribution of pathogens associated with HAP and their antimicrobial susceptibilities. ÎFor patients being treated empirically for HAP, ATS and IDSA recommend prescribing an antibiotic with activity against S. aureus (S-L). (See below for recommendations regarding empiric coverage of MRSA vs MSSA.) • For patients with HAP who are being treated empirically and have either a risk factor for MRSA infection (ie, prior intravenous antibiotic use within 90 days, hospitalization in a unit where 20% of S. aureus isolates are methicillin resistant, or the prevalence of MRSA is not known, or who are at high risk for mortality, ATS and IDSA suggest prescribing an antibiotic with activity against MRSA (W-VL). (Risk factors for mortality include need for ventilatory support due to HAP and septic shock. • For patients with HAP who require empiric coverage for MRSA, ATS and IDSA recommend vancomycin or linezolid rather than an alternative antibiotic (S-L). • For patients with HAP who are being treated empirically and have no risk factors for MRSA infection and are not at high risk of mortality, ATS and IDSA suggest prescribing an antibiotic with activity against MSSA. 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. Oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven MSSA but are not necessary for empiric coverage of HAP if one of the above agents is used (W-VL). Î For patients with HAP who are being treated empirically, ATS and IDSA recommend prescribing antibiotics with activity against P. aeruginosa and other Gram-negative bacilli (S-VL). • For patients with HAP who are being treated empirically and have factors increasing the likelihood for Pseudomonas or other Gram-negative infection (ie, prior intravenous antibiotic use within 90 days) or a high risk for mortality, ATS and IDSA suggest prescribing antibiotics from 2 different classes with activity against P. aeruginosa (W-VL). (Risk factors for mortality include need for ventilatory support due to HAP and septic shock. All other patients with HAP who are being treated empirically may be prescribed a single antibiotic with activity against P. aeruginosa. • For patients with HAP who are being treated empirically, ATS and IDSA recommend NOT using an aminoglycoside as the sole antipseudomonal agent (S-VL). S, strong ; W, weak strength of recommendation H, high; M, moderate; L, low; VL, very low quality of evidence