VAP

Question 1

VAP Definition

Answer 1

A type of HAP that develops 48 h s/p intubation

Question 2

WHat are some possible stem clues that tell you this could be VAP>

Answer 2

• Difficult to extubate
• Lack of improvement
• New CXR infiltrates
• New fevers
• Changes in baseline labs

Question 3

Etiologic agents for new onset HAP and VAP (<5 d admission, no other RFs for MDR pathogens

Answer 3

• S. pneumo
• H. influenzae
• Enteric gram - bacilli

“SHE has new onset VAP”

Question 4

Etiologic agents for late onset HAP and VAP (>5 d admission, RFs for MDR pathogens present)

Answer 4

-S. aureus

-Gram - enterics
- ESKAPE (E. coli, Serratia marcescens, Klebsiella,
Acinetobacter baumannii, P. aeruginosa, E. coli)

• gram - enterics can cause both early and late onset VPA*
• S. aureus=late, S. pneumo= newmo*

Question 5

Initial tx of HAP, VAP

Answer 5

Cefepime, Ciprofloxacin, and Vancomycin. Must have strong evidence for fungal before adding on tx due to toxicity risk.