Infectious Diseases I
Characteristic
2005 Guidelines
2016 Guidelines
Classification
Early onset or late onset
No longer differentiate VAP episodes based on
time from hospital admission
Emphasis on local risk assessment for P.
aeruginosa and MRSA occurring early in
hospitalization
MDRO Risk
Factors
| β’ | Antibiotic therapy in preceding 90 days |
|---|---|
| β’ | Chronic dialysis within 30 days |
| β’ | Current hospitalization of 5 days or more |
| β’ | Home chronic wound care |
| β’ | Home infusion therapy |
| β’ | Hospitalization in the preceding 90 days |
| β’ | Immunosuppressive disease and/or |
therapy
| β’ | Known contact or colonization with |
|---|
MDROs
| β’ | Residence in a nursing home or |
|---|
extended-care facility
| β’ | Prior intravenous antibiotic therapy in |
|---|
preceding 90 days
| β’ | Acute renal replacement therapy before VAP |
|---|
onset
| β’ | 5 or more days of hospitalization before the |
|---|
occurrence of VAP
| β’ | Septic shock at the time of VAP |
|---|---|
| β’ | ARDS preceding VAP |
Empiric Therapy
Categorized based on early onset or late
onset and presence of MDRO risk factor
| β’ | Early onset without MDRO risk factor: |
|---|
no antipseudomonal or MRSA coverage
| β’ | Late onset or early onset with MDRO |
|---|
risk factor: dual antipseudomonal and
MRSA coverage
Recommend coverage for MSSA, P. aeruginosa,
and other gram-negative bacilli in all empiric
regimens.
Suggest including an agent active against MRSA
if any of the following:
| β’ | MDRO risk factor for antimicrobial resistance |
|---|---|
| β’ | ICU MRSA prevalence greater than 10%-20% |
of all S. aureus
| β’ | Prevalence of MRSA is not known |
|---|
Suggest prescribing dual antipseudomonal antibi-
otics from different classes if any of the following:
| β’ | MDRO risk factor for antimicrobial resistance |
|---|---|
| β’ | ICUs with greater than 10% of gram-negative |
isolates are resistant to an agent being
considered for monotherapy
| β’ | ICU where local antimicrobial susceptibility |
|---|
rates unavailable
Aminoglycosides No specific recommendation
Suggest avoiding if alternative agents with
adequate gram-negative activity are available
Colistin
No specific recommendation
Suggest avoiding if alternative agents with
adequate gram-negative activity are available
Duration of
Definitive
Therapy
In patients who received appropriate
empiric antibiotic therapy:
| β’ | Nonβlactose-fermenting Gram negative |
|---|
bacilli: 14 days
| β’ | All other pathogens: 7 days |
|---|
Recommend 7 days rather than longer durations
regardless of pathogen
Suggest using procalcitonin plus clinical criteria
to guide discontinuation of antibiotic therapy,
rather than clinical criteria alone