Hospital-acquired pneumonia

Also known as: HAP · nosocomial pneumonia · VAP · ventilator-associated pneumonia

Also relevant to Infectious DiseaseAlso relevant to Emergency & Critical Care

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United StatesATS/CHEST

Current

Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by IDSA and ATS

IDSA / ATS · 2016

IDSA and ATS provide evidence-based guidance on diagnosing and treating hospital-acquired and ventilator-associated pneumonia in adults, including empiric regimen selection and de-escalation. IDSA still lists this guideline as current.

IDSA labels the 2016 document as its current HAP/VAP practice guideline for clinicians caring for at-risk adults. source
Prevention measures are handled by separate SHEA guidance rather than within this document. source

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EuropeERS (global: GOLD/GINA)

Current

International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia

ERS/ESICM/ESCMID/ALAT · 2017

A four-society European-led guideline covering diagnosis, empiric and targeted treatment, and prevention of HAP and VAP in adults. It was written to replace European guidance that was by then roughly a decade old.

The panel of 15 clinical experts and two methodologists used GRADE to answer seven clinical questions on HAP/VAP. source
The authors explicitly aimed to reconcile differences between European and US approaches to HAP/VAP management. source

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US vs EU key differences

Sampling strategy differs: the 2016 IDSA/ATS guideline favours non-invasive sampling with semiquantitative cultures, while the European guideline accepts either invasive or non-invasive sampling as equally reasonable. source
Blood cultures: the US guideline advises both respiratory and blood cultures in suspected HAP/VAP, whereas the European guideline recommends respiratory sampling only. source
The European guideline retains the early- versus late-onset VAP distinction and issues specific recommendations for early-onset disease; the US panel rejected that split as insufficiently evidence-based. source
Notable convergence: both documents abandoned the healthcare-associated pneumonia (HCAP) category, adopted GRADE, endorse local antibiograms to steer empiric choice, and settle on roughly 7-8 days of therapy for most patients with de-escalation. source
Inhaled antibiotics are treated differently: the US guideline reserves them for Gram-negative organisms susceptible only to aminoglycosides or polymyxins, while the European guideline makes no specific recommendation. source

What changed recently

US2005 → 20162016-07-14
The 2016 revision dropped healthcare-associated pneumonia as a separate category, on the reasoning that recent healthcare contact is a poor predictor of multidrug-resistant organisms and that those patients belong in the community-acquired pneumonia pathway. It also moved to GRADE methodology, pushed institutions to use local antibiograms to narrow empiric MRSA and double gram-negative coverage, and favoured noninvasive sampling with semiquantitative cultures over invasive quantitative techniques.
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