Management of Adults with Hospital-Acquired and Ventilator-Associated Pneumonia: IDSA/ATS Guidelines

HAP and VAP are the most common ICU infections. The 2016 guideline updated antibiotic selection based on local resistance patterns and de-escalation principles.

Evidence-based guideline using GRADE methodology.

Key recommendations: (1) 7-day antibiotic course for VAP (not longer); (2) Cover MRSA only if risk factors present or >10–20% local MRSA prevalence; (3) Cover Pseudomonas with two agents only if high risk; (4) Procalcitonin can guide de-escalation; (5) Avoid aminoglycosides as monotherapy for VAP.

Know the MRSA risk factors for VAP (prior MRSA, IV antibiotics in 90 days, structural lung disease, ICU MRSA prevalence >10–20%). 7 days is adequate for most VAP. De-escalate based on cultures.

Local resistance patterns vary — must apply local antibiogram. Some recommendations based on observational data.