HAP/VAP

Question 1

microbiology for HAP/VAP

Answer 1

S. pneumoniae 
S. aureus 
H. influenzae
E. coli 
Proteus spp
S. marcescens 
Enterobacter spp 
K. pneumoniae 
Acinetobacter spp 
P. aeruginosa

Question 2

MDRO risk factors for HAP/VAP

Answer 2

Prior IV antibiotics in past 90d

Septic shock at VAP onset
ARDS preceding VAP onset
≥ 5d hospitalisation
Acute renal replacement therapy

Question 3

HAP/VAP treatment

Answer 3

anti-pseudomonal B-lactam: piperacillin/tazabactam IV 4.5g Q6-8h; cefepime IV 2g Q8h; meropenem IV 1g Q8h; imipenem IV 500mg Q6h

OR
anti-pseudomonal FQ: levofloxacin IV 750mg Q24h

Question 4

Indications for MRSA coverage for HAP/VAP

Answer 4

MDRO risk factor
Mortality risk factor
MRSA > 20% or unknown `

Question 5

MRSA coverage treatment for HAP/VAP

Answer 5

ADD
vancomycin IV 15mg/kg Q8-12h
Linezolid IV 600mg Q12h

Question 6

indications for additional gram -ve coverage for HAP/VAP

Answer 6

MDRO risk factor
mortility risk factor (HAP)
single anti-pseudomonal agent with activity < 90% or unknown (VAP)

Question 7

Additional gram -ve coverage for HAP/VAP

Answer 7

Add drug different from backbone regimen 
Gentamicin IV 5-7mg/kg Q24h 
amikacin IV 15mg/kg Q24h 
tobramycin IV 
ciprofloxacin IV 400mg Q8-12h 
levofloxacin IV 750mg Q24h

Question 8

clinical improvement, treatment duration in HAP/VAP

Answer 8

72h

7d regardless of pathogen

Question 9

HAP mortality risk factors

Answer 9

requiring mechanical ventilation as a result of HAP

in septic shock

Question 10

patient related risk factors in HAP/VAP

Answer 10

elderly 
smoking 
COPD, cancer, immunosuppression 
prolonged hospitalisation 
coma, impaired consciousness 
malnutrition

Question 11

infection control related risk factors in HAP/VAP

Answer 11

hand hygiene compliance

contaminated respiratory care devices

Question 12

healthcare-related risk factors in HAP/VAP

Answer 12

prior antibiotics use 
sedatives 
opioid analgesics 
mechanical ventilation 
supine position