How is hospital-acquired pneumonia (HAP) treated?

Updated: Apr 15, 2021
  • Author: Kartika Shetty, MD, FACP; Chief Editor: John L Brusch, MD, FACP  more...
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MSSA should be covered unless the patient has risk factors for MRSA, including intravenous antibiotic use within the preceding 90 days, exposure to a hospital unit where more than 20% of S aureus isolates are MRSA, or a high risk for death (eg, need for ventilatory support due to septic shock). Vancomycin or linezolid should be used, guided by local antibiogram, to empirically cover MRSA.

For empiric coverage of MSSA, piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem are preferred. In cases of proven MSSA infection, oxacillin, nafcillin, or cefazolin is favored.

Double coverage against P aeruginosa should be provided in the empiric treatment of individuals with HAP who are likely to have Pseudomonas and other gram-negative infections or who are at a high risk for mortality (need for ventilatory support and/or septic shock). For all other cases, single coverage of P aeruginosa is indicated. [16]


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