Pathogen Directed Therapy - HAP and VAP

Question 1

MRSA

Answer 1

vancomycin or linezolid

[ceftaroline not FDA-approved, can still use but expensive; daptomycin = DO NOT USE IN PNEUMONIAE]

Question 2

MSSA

Answer 2

nafcillin, oxacillin, cefazolin

Question 3

Enterobacterales

Answer 3

Many

Question 4

ESBL-producer

ESBL = extended spectrum beta-lactamase

Answer 4

carbapenem, ceftazidime/avibactam

Question 5

MBL-producer

Answer 5

aztreonam + ceftazidime/avibactam,

aztreonam mono if susceptible

Question 6

KPC-producer

Answer 6

ceftazidime/avibactam

meropenem/vaborbactam

imipenem/cilastatin/relebactam

Question 7

P. aeruginosa

Answer 7

Monotherapy if not in septic shock or high risk of death

Combination therapy (2 agents) if in septic shock or high death risk

Ceftolozane/tazobactam, cetazidime/avibactam,
imipenem/cilastatin/relebactam, cefiderocol if MDR

Question 8

If patient on valproic acid…

Answer 8

DO NOT USE WITH CARBAPENEM

Question 9

Acinetobacter

Answer 9

carbapenem or ampicillin/sulbactam if susceptible

Cefiderocol if resistant to carbapenem or ampicillin/sulbactam

Question 10

Polymyxin (Colistin, polymyxin B)

Answer 10

IV plus inhaled colistin if MDR to all other options