Hospital & Ventilator Pneumonia

• VAP prevention bundle: head-up 30–45°, daily SAT/SBT, subglottic secretion drainage (when available), oral care, DVT prophylaxis.
• Empiric therapy: antipseudomonal β-lactam (cefepime/pip-tazo/meropenem) ± an MRSA agent with risk factors; de-escalate by cultures.
• A 7-day course is typical, adjusted to response/source control; a negative MRSA nasal PCR supports stopping vancomycin only with low clinical suspicion and respiratory-culture/local-policy review.
• Aminoglycosides must NOT be monotherapy. Inhaled antibiotics are not routine with an active systemic β-lactam; reserve selected rescue for resistant Gram-negatives with ID/respiratory advice.

Hospital- or ventilator-associated pneumonia

First tests: Chest X-ray, Respiratory culture, Blood cultures, Full blood count, Sodium, potassium, bicarbonate, urea and creatinine.

Only if indicated: Bronchoscopy / BAL, CT chest.

Repeat monitoring: Culture and clinical review.

Pneumonia — acquisition not yet established

First tests: Chest X-ray, Full blood count, Sodium, potassium, bicarbonate, urea and creatinine.

Only if indicated: Arterial blood gas, Blood cultures, Respiratory culture, Respiratory viral NAAT.

Repeat monitoring: Oxygenation and clinical response.

• Step-by-Step Management of Nosocomial Pneumonia