When is antimicrobial therapy indicated for nosocomial pneumonia?

Updated: Apr 15, 2021
  • Author: Kartika Shetty, MD, FACP; Chief Editor: John L Brusch, MD, FACP  more...
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The specific pathogen that causes a given case of nosocomial pneumonia is usually unknown. Therefore, empiric antimicrobial therapy is the only practical approach. These regimens should be based on the local profile of organisms associated with hospital-acquired pneumonia (HAP) and their antibiotic sensitivities. [30]  Traditionally, nosocomial pneumonias have been treated for 7-14 days. However, ventilator-associated pneumonia (VAP) (except due to nonfermenting gram-negative rods [eg, P aeruginosa]) can be successfully treated in 7 days). If the patient receives appropriate antimicrobial therapy for 2 weeks and does not respond (i.e., improved infiltrates findings on chest radiograph), initiate a diagnostic workup to detect nonbacterial infections (eg, herpesvirus type 1 [HSV-1] pneumonitis) or noninfectious disease mimics (eg, bronchogenic carcinomas).

Cefiderocol is a cephalosporin antibiotic that is capable of penetrating outer cell membranes of Gram-negative bacteria by acting as a siderophore. In September 2020, it gained FDA approval for hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) caused by the following susceptible Gram-negative microorganisms: Acinetobacter baumannii complex, Escherichia coliEnterobacter cloacae complex, Klebsiella pneumoniaePseudomonas aeruginosa, and Serratia marcescens. Approval was based on the phase 3 APEKS-NP study. Results showed cefiderocol was noninferior to high-dose meropenem for all-cause mortality at Days 14 and 28. [31]


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