Monday, August 1, 2016

IDSA Guidelines 2016: HAP, VAP

PulmCCM - Jul 30, 2016
..."In the most recent update, however, HCAP has been scrapped – at least for now. A meta-analysis of 24 studies including more than 20,000 patients found that HCAP was associated with MDROs [e.g. MRSA, pseudomonas], however, the aforementioned HCAP risk factors were neither sensitive nor specific to identify at-risk patients. The poor clinical outcome noted with HCAP patients was felt to be related more strongly with age and comorbidities rather than MDROs per se. Further, there was a large publication bias suspected. The panel unanimously decided that HCAP should not be included in the HAP & VAP guidelines.
However, as a separate entity, HCAP – or some modification thereof – may be included in a forthcoming revision of the community-acquired pneumonia [CAP] guidelines...
While the current guidelines discuss a number of issues germane to HAP and VAP including: microbiological evaluation, ventilator-associated tracheobronchitis, the use of biomarkers and clinical prediction scores, inhaled antibiotics, etc. this post will focus on standard, empiric therapy as this is a common clinical quandary [see figure 1]..:"