Highlights & Basics
- Hospital-acquired pneumonia (HAP) is typically caused by bacteria, especially aerobic gram-negative bacilli, such as Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and Acinetobacter species.
- Patients with hospital-acquired pneumonia usually present with a combination of fever (or hypothermia), leukocytosis (or leukopenia), increased tracheal secretions, and poor oxygenation. Alveolar shadowing on chest x-ray or computed tomography scan supports the diagnosis.
- A lower respiratory culture should be obtained before initiating antibiotics; culture results should be used to de-escalate antibiotics and focus on the offending pathogen.
- Broad-spectrum antimicrobials should be used initially for patients with risk factors for multidrug-resistant pathogens.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Portable chest x-ray of a patient with HAP. Note obscured left hemidiaphragm due to a left lower lobe opacity and an obscured heart border due to a left upper lobe or lingular opacity
CT scan showing bibasilar opacities of patient with HAP
CT scan of a patient with a large, dense left lower lobe infiltrate
CT scan of a patient with a left lower lobe alveolar infiltrate (blue arrow), bilateral pleural effusions (yellow arrowheads), and right basilar atelectasis; notice the line separating the two shades of gray representing the infiltrate and the fluid
Citations
Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016 Sep 1;63(5):e61-111.[Abstract][Full Text]
Klompas M, Branson R, Cawcutt K, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2022 Jun;43(6):687-713.[Abstract][Full Text]
1. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016 Sep 1;63(5):e61-111.[Abstract][Full Text]
2. Iregui M, Ward S, Sherman G, et al. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest. 2002 Jul;122(1):262-8.[Abstract]
3. Tablan OC, Anderson LJ, Besser R, et al. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004 Mar 26;53(RR-3):1-36.[Abstract][Full Text]
4. Richards MJ, Edwards JR, Culver DH, et al. Nosocomial infections in medical intensive care units in the United States: National Nosocomial Infections Surveillance System. Crit Care Med. 1999 May;27(5):887-92.[Abstract]
5. Muscedere JG, Day A, Heyland DK. Mortality, attributable mortality, and clinical events as end points for clinical trials of ventilator-associated pneumonia and hospital-acquired pneumonia. Clin Infect Dis. 2010 Aug 1;51 Suppl 1:S120-5.[Abstract][Full Text]
6. Kollef MH, Hamilton CW, Ernst FR. Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol. 2012 Mar;33(3):250-6.[Abstract]
7. Heyland DK, Cook DJ, Griffith L, et al. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. Am J Respir Crit Care Med. 1999 Apr;159(4 Pt 1):1249-56.[Abstract][Full Text]
8. Mosier MJ, Pham TN. American Burn Association practice guidelines for prevention, diagnosis, and treatment of ventilator-associated pneumonia (VAP) in burn patients. J Burn Care Res. 2009 Nov-Dec;30(6):910-28.[Abstract]
9. Rubinstein E, Kollef MH, Nathwani D. Pneumonia caused by methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2008 Jun 1;46 Suppl 5:S378-85.[Abstract]
10. Allen M, Mirsaeidi M, Peyrani P, et al. Emergence of community-associated MRSA as etiology of hospital-acquired pneumonia and ventilator-associated pneumonia: results from the IMPACT HAP study. Paper presented at: 46th Annual Meeting of ICAAC/IDSA; October 2008; Washington, D.C.
11. Suaya JA, Fletcher MA, Georgalis L, et al. Identification of Streptococcus pneumoniae in hospital-acquired pneumonia in adults. J Hosp Infect. 2021 Feb;108:146-57.[Abstract]
12. el-Ebiary M, Sarmiento X, Torres A, et al. Prognostic factors of severe Legionella pneumonia requiring admission to ICU. Am J Respir Crit Care Med. 1997 Nov;156(5):1467-72.[Abstract][Full Text]
13. Wilde JA, McMillan JA, Serwint J, et al. Effectiveness of influenza vaccine in health care professionals: a randomized trial. JAMA. 1999 Mar 10;281(10):908-13.[Abstract][Full Text]
14. Sarubbi FA Jr, Kopf HB, Wilson MB, et al. Increased recovery of Aspergillus flavus from respiratory specimens during hospital construction. Am Rev Respir Dis. 1982 Jan;125(1):33-8.[Abstract]
15. Cook D, De Jonghe B, Brochard L, et al. Influence of airway management on ventilator-associated pneumonia: evidence from randomized trials. JAMA. 1998 Mar 11;279(10):781-7.[Abstract]
16. Bergmans DC, Bonten MJ, van Tiel FH, et al. Cross-colonisation with Pseudomonas aeruginosa of patients in an intensive care unit. Thorax. 1998 Dec;53(12):1053-8.[Abstract][Full Text]
17. Craven DE, Steger KA. Nosocomial pneumonia in mechanically ventilated adult patients: epidemiology and prevention in 1996. Semin Respir Infect. 1996 Mar;11(1):32-53.[Abstract]
18. Pittet D, Hugonnet S, Harbarth S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet. 2000 Oct 14;356(9238):1307-12.[Abstract]
19. Kollef MH. The prevention of ventilator-associated pneumonia. N Engl J Med. 1999 Feb 25;340(8):627-34.[Abstract]
20. Cook D, Guyatt G, Marshall J, et al. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. N Engl J Med. 1998 Mar 19;338(12):791-7.[Abstract][Full Text]
21. Donowitz GR, Mandell GL. Acute pneumonia. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and practice of infectious diseases. 6th ed. Philadelphia, PA: Churchill Livingstone; 2005:819-45.
22. Hess DR. Patient positioning and ventilator-associated pneumonia. Respir Care. 2005 Jul;50(7):892-8; discussion 898-9.[Abstract]
23. Drakulovic MB, Torres A, Bauer TT, et al. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet. 1999 Nov 27;354(9193):1851-8.[Abstract]
24. Niël-Weise BS, Gastmeier P, Kola A, et al. An evidence-based recommendation on bed head elevation for mechanically ventilated patients. Crit Care. 2011;15(2):R111.[Abstract][Full Text]
25. Klompas M, Branson R, Cawcutt K, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2022 Jun;43(6):687-713.[Abstract][Full Text]
26. Zhao T, Wu X, Zhang Q, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2020 Dec 24;12(12):CD008367.[Abstract][Full Text]
27. Hellyer TP, Ewan V, Wilson P, et al. The Intensive Care Society recommended bundle of interventions for the prevention of ventilator-associated pneumonia. J Intensive Care Soc. 2016 Aug;17(3):238-43.[Abstract][Full Text]
28. Gao F, Yang LH, He HR, et al. The effect of reintubation on ventilator-associated pneumonia and mortality among mechanically ventilated patients with intubation: A systematic review and meta-analysis. Heart Lung. 2016 Jul-Aug;45(4):363-71.[Abstract]
29. Schleder B, Stott K, Lloyd RC. The effect of a comprehensive oral care protocol on patients at risk for ventilator-associated pneumonia. Crit Care Nurse Clinic N Am. 2002;4:27-30.
30. Allegranzi B, Pittet D. Preventing infections acquired during health-care delivery. Lancet. 2008 Nov 15;372(9651):1719-20.[Abstract]
31. Boyce JM, Pittet D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recomm Rep. 2002 Oct 25;51(RR-16):1-45, quiz CE1-4.[Abstract][Full Text]
32. Burns KE, Meade MO, Premji A, et al. Noninvasive positive-pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database Syst Rev. 2013 Dec 9;(12):CD004127.[Abstract][Full Text]
33. Ou J, Chen H, Li L, et al. The role of non-invasive ventilation used immediately after planned extubation for adults with chronic respiratory disorders. Saudi Med J. 2018 Feb;39(2):131-6.[Abstract][Full Text]
34. Granton D, Chaudhuri D, Wang D, et al. High-flow nasal cannula compared with conventional oxygen therapy or noninvasive ventilation immediately postextubation: a systematic review and meta-analysis. Crit Care Med. 2020 Nov;48(11):e1129-36.[Abstract]
35. Sang L, Nong L, Zheng Y, et al. Effect of high-flow nasal cannula versus conventional oxygen therapy and non-invasive ventilation for preventing reintubation: a Bayesian network meta-analysis and systematic review. J Thorac Dis. 2020 Jul;12(7):3725-36.[Abstract][Full Text]
36. Han JN, Liu YP, Ma S, et al. Effects of decreasing the frequency of ventilator circuit changes to every 7 days on the rate of ventilator-associated pneumonia in a Beijing hospital. Respir Care. 2001 Sep;46(9):891-6.[Abstract]
37. Han J, Liu Y. Effect of ventilator circuit changes on ventilator-associated pneumonia: a systematic review and meta-analysis. Respir Care. 2010 Apr;55(4):467-74.[Abstract][Full Text]
38. Lewis SR, Schofield-Robinson OJ, Rhodes S, et al. Chlorhexidine bathing of the critically ill for the prevention of hospital-acquired infection. Cochrane Database Syst Rev. 2019 Aug 30;8(8):CD012248.[Abstract][Full Text]
39. Alexiou VG, Ierodiakonou V, Dimopoulos G, et al. Impact of patient position on the incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials. J Crit Care. 2009 Dec;24(4):515-22.[Abstract]
40. Kollef MH, Afessa B, Anzueto A, et al. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA. 2008 Aug 20;300(7):805-13.[Abstract][Full Text]
41. Damas P, Frippiat F, Ancion A, et al. Prevention of ventilator-associated pneumonia and ventilator-associated conditions: a randomized controlled trial with subglottic secretion suctioning. Crit Care Med. 2015 Jan;43(1):22-30.[Abstract]
42. Mao Z, Gao L, Wang G, et al. Subglottic secretion suction for preventing ventilator-associated pneumonia: an updated meta-analysis and trial sequential analysis. Crit Care. 2016 Oct 28;20(1):353.[Abstract][Full Text]
43. Lacherade JC, De Jonghe B, Guezennec P, et al. Intermittent subglottic secretion drainage and ventilator-associated pneumonia: a multicenter trial. Am J Respir Crit Care Med. 2010 Oct 1;182(7):910-7.[Abstract][Full Text]
44. Gillies D, Todd DA, Foster JP, Batuwitage BT. Heat and moisture exchangers versus heated humidifiers for mechanically ventilated adults and children. Cochrane Database Syst Rev. 2017 Sep 14;(9):CD004711.[Abstract][Full Text]
45. Siempos II, Ntaidou TK, Falagas ME. Impact of the administration of probiotics on the incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials. Crit Care Med. 2010;38:954-962.[Abstract]
46. Bo L, Li J, Tao T, et al. Probiotics for preventing ventilator-associated pneumonia. Cochrane Database Syst Rev. 2014 Oct 25;10(10):CD009066.[Abstract][Full Text]
47. Batra P, Soni KD, Mathur P. Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials. J Intensive Care. 2020 Oct 15;8:81.[Abstract][Full Text]
48. Su M, Jia Y, Li Y, et al. Probiotics for the prevention of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials. Respir Care. 2020 May;65(5):673-85.[Abstract][Full Text]
49. Johnstone J, Meade M, Lauzier F, et al. Effect of probiotics on incident ventilator-associated pneumonia in critically ill patients: a randomized clinical trial. JAMA. 2021 Sep 21;326(11):1024-33.[Abstract][Full Text]
50. Li Z, Qi J, Zhao X, et al. Risk-benefit profile of gastric vs transpyloric feeding in mechanically ventilated patients: a meta-analysis. Nutr Clin Pract. 2016 Feb;31(1):91-8.[Abstract]
51. van Zanten AR, Brinkman S, Arbous MS, et al. Guideline bundles adherence and mortality in severe sepsis and septic shock. Crit Care Med. 2014 Aug;42(8):1890-8.[Abstract]
52. Padhani ZA, Moazzam Z, Ashraf A, et al. Vitamin C supplementation for prevention and treatment of pneumonia. Cochrane Database Syst Rev. 2021 Nov 18;11(11):CD013134.[Abstract][Full Text]
53. Public Health England. Insufficient evidence for vitamin D preventing or treating ARTIs. Jul 2020 [internet publication].[Full Text]
54. Cheng GS, Crothers K, Aliberti S, et al. Immunocompromised host pneumonia: definitions and diagnostic criteria: an official American Thoracic Society workshop report. Ann Am Thorac Soc. 2023 Mar;20(3):341-53.[Abstract][Full Text]
55. Staub LJ, Biscaro RRM, Maurici R. Accuracy and Applications of Lung Ultrasound to Diagnose Ventilator-Associated Pneumonia: A Systematic Review. J Intensive Care Med. 2018 Aug;33(8):447-55.[Abstract][Full Text]
56. Qaseem A, Etxeandia-Ikobaltzeta I, Mustafa RA, et al. Appropriate use of point-of-care ultrasonography in patients with acute dyspnea in emergency department or inpatient settings: a clinical guideline from the American College of Physicians. Ann Intern Med. 2021 Jul;174(7):985-93.[Abstract][Full Text]
57. Torres A, Ewig S. Diagnosing ventilator-associated pneumonia. N Engl J Med. 2004 Jan 29;350(5):433-5.[Abstract]
58. Canadian Critical Care Trials Group. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med. 2006 Dec 21;355(25):2619-30.[Abstract][Full Text]
59. Lam SW, Bauer SR, Fowler R, et al. Systematic Review and Meta-Analysis of Procalcitonin-Guidance Versus Usual Care for Antimicrobial Management in Critically Ill Patients: Focus on Subgroups Based on Antibiotic Initiation, Cessation, or Mixed Strategies. Crit Care Med. 2018 May;46(5):684-90.[Abstract][Full Text]
60. Hellyer TP, McAuley DF, Walsh TS, et al. Biomarker-guided antibiotic stewardship in suspected ventilator-associated pneumonia (VAPrapid2): a randomised controlled trial and process evaluation. Lancet Respir Med. 2020 Feb;8(2):182-91.[Abstract][Full Text]
61. Parente DM, Cunha CB, Mylonakis E, et al. The clinical utility of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA pneumonia: a diagnostic meta-analysis with antimicrobial stewardship implications. Clin Infect Dis. 2018 Jun 18;67(1):1-7.[Abstract][Full Text]
62. Sahn SA. Diagnosis and management of parapneumonic effusions and empyema. Clin Infect Dis. 2007 Dec 1;45(11):1480-6.[Abstract][Full Text]
63. National Institute for Health and Care Excellence. Pneumonia in adults: diagnosis and management. Jul 2022 [internet publication].[Full Text]
64. Torres A, Niederman MS, Chastre J, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J. 2017 Sep 10;50(3):1700582.[Abstract][Full Text]
65. Clec'h C, Timsit JF, De Lassence A, et al. Efficacy of adequate early antibiotic therapy in ventilator-associated pneumonia: influence of disease severity. Intensive Care Med. 2004 Jul;30(7):1327-33.[Abstract]
66. Muscedere JG, Shorr AF, Jiang X, et al. The adequacy of timely empiric antibiotic therapy for ventilator-associated pneumonia: an important determinant of outcome. J Crit Care. 2012 Jun;27(3):322.e7-14.[Abstract]
67. Ibrahim EH, Ward S, Sherman G, et al. Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Crit Care Med. 2001 Jun;29(6):1109-15.[Abstract]
68. Manzur A, Tubau F, Pujol M, et al. Nosocomial outbreak due to extended-spectrum-beta-lactamase- producing Enterobacter cloacae in a cardiothoracic intensive care unit. J Clin Microbiol. 2007 Aug;45(8):2365-9.[Abstract][Full Text]
69. Mentzelopoulos SD, Pratikaki M, Platsouka E, et al. Prolonged use of carbapenems and colistin predisposes to ventilator-associated pneumonia by pandrug-resistant Pseudomonas aeruginosa. Intensive Care Med. 2007 Sep;33(9):1524-32.[Abstract]
70. European Medicines Agency. Quinolone- and fluoroquinolone-containing medicinal products. November 2018 [internet publication].[Full Text]
71. Medicines and Healthcare products Regulatory Agency. Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects. March 2019 [internet publication].[Full Text]
72. US Food and Drug Administration. FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. July 2016 [internet publication].[Full Text]
73. Food and Drug Administration. FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients. Dec 2018 [internet publication].[Full Text]
74. US Food and Drug Administration. FDA Drug Safety Communication. FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. October 2018 [internet publication].[Full Text]
75. National Institute for Health and Care Excellence. Pneumonia (hospital-acquired): antimicrobial prescribing. September 2019 [internet publication].[Full Text]
76. Franzetti F, Antonelli M, Bassetti M, et al. Consensus document on controversial issues for the treatment of hospital-associated pneumonia. Int J Infect Dis. 2010 Oct;14 Suppl 4:S55-65.[Abstract]
77. Heyland DK, Dodek P, Muscedere J, et al. Randomized trial of combination versus monotherapy for the empiric treatment of suspected ventilator-associated pneumonia. Crit Care Med. 2008 Mar;36(3):737-44.[Abstract]
78. Kim JW, Chung J, Choi SH, et al. Early use of imipenem/cilastatin and vancomycin followed by de-escalation versus conventional antimicrobials without de-escalation for patients with hospital-acquired pneumonia in a medical ICU: a randomized clinical trial. Crit Care. 2012 Feb 15;16(1):R28.[Abstract][Full Text]
79. Kett DH, Cano E, Quartin AA, et al. Implementation of guidelines for management of possible multidrug-resistant pneumonia in intensive care: an observational, multicentre cohort study. Lancet Infect Dis. 2011 Mar;11(3):181-9.[Abstract]
80. Howatt M, Klompas M, Kalil AC, et al. Carbapenem antibiotics for the empiric treatment of nosocomial pneumonia: a systematic review and meta-analysis. Chest. 2021 Mar;159(3):1041-54.[Abstract]
81. Torres A, Zhong N, Pachl J, et al. Ceftazidime-avibactam versus meropenem in nosocomial pneumonia, including ventilator-associated pneumonia (REPROVE): a randomised, double-blind, phase 3 non-inferiority trial. Lancet Infect Dis. 2018 Mar;18(3):285-95.[Abstract]
82. Freire AT, Melnyk V, Kim MJ, et al. Comparison of tigecycline with imipenem/cilastatin for the treatment of hospital-acquired pneumonia. Diagn Microbiol Infect Dis. 2010 Oct;68(2):140-51.[Abstract]
83. McGovern PC, Wible M, El-Tahtawy A, et al. All-cause mortality imbalance in the tigecycline phase 3 and 4 clinical trials. Int J Antimicrob Agents. 2013 May;41(5):463-7.[Abstract]
84. Rubinstein E, Cammarata S, Oliphant T, et al. Linezolid (PNU-100766) versus vancomycin in the treatment of hospitalized patients with nosocomial pneumonia: a randomized, double-blind, multicenter study. Clin Infect Dis. 2001 Feb 1;32(3):402-12.[Abstract][Full Text]
85. Wunderink RG, Cammarata SK, Oliphant TH. Continuation of a randomized, double-blind, multicenter study of linezolid versus vancomycin in the treatment of patients with nosocomial pneumonia. Clin Ther. 2003 Mar;25(3):980-92.[Abstract]
86. Kollef MH, Rello J, Cammarata SK, et al. Clinical cure and survival in Gram-positive ventilator-associated pneumonia: retrospective analysis of two double-blind studies comparing linezolid with vancomycin. Intensive Care Med. 2004 Mar;30(3):388-94. [Abstract]
87. Kalil AC, Murthy MH, Hermsen ED, et al. Linezolid versus vancomycin or teicoplanin for nosocomial pneumonia: a systematic review and meta-analysis. Crit Care Med. 2010 Sep;38(9):1802-8.[Abstract]
88. Walkey AJ, O'Donnell MR, Wiener RS. Linezolid vs glycopeptide antibiotics for the treatment of suspected methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a meta-analysis of randomized controlled trials. Chest. 2011 May;139(5):1148-55.[Abstract]
89. Wunderink RG, Niederman MS, Kollef MH, et al. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study. Clin Infect Dis. 2012 Mar 1;54(5):621-9.[Abstract][Full Text]
90. Hilf M, Yu VL, Sharp J, et al. Antibiotic therapy for Pseudomonas aeruginosa bacteremia: outcome correlations in a prospective study of 200 patients. Am J Med. 1989 Nov;87(5):540-6.[Abstract]
91. Fartoukh M, Maître B, Honoré S, et al. Diagnosing pneumonia during mechanical ventilation: the clinical pulmonary infection score revisited. Am J Respir Crit Care Med. 2003 Jul 15;168(2):173-9.[Abstract][Full Text]
92. Trouillet JL, Vuagnat A, Combes A, et al. Pseudomonas aeruginosa ventilator-associated pneumonia: comparison of episodes due to piperacillin-resistant versus piperacillin-susceptible organisms. Clin Infect Dis. 2002 Apr 15;34(8):1047-54.[Abstract][Full Text]
93. Eljaaly K, Enani MA, Al-Tawfiq JA. Impact of carbapenem versus non-carbapenem treatment on the rates of superinfection: A meta-analysis of randomized controlled trials. J Infect Chemother. 2018 Nov;24(11):915-20.[Abstract][Full Text]
94. Garnacho-Montero J, Sa-Borges M, Sole-Violan J, et al. Optimal management therapy for Pseudomonas aeruginosa ventilator-associated pneumonia: an observational, multicenter study comparing monotherapy with combination antibiotic therapy. Crit Care Med. 2007 Aug;35(8):1888-95.[Abstract]
95. Paul M, Benuri-Silbiger I, Soares-Weiser K, et al. Beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for sepsis in immunocompetent patients: systematic review and metaanalysis of randomised trials. BMJ. 2004 Mar 20;328(7441):668.[Abstract][Full Text]
96. Cometta A, Baumgartner JD, Lew D, et al. Prospective randomized comparison of imipenem monotherapy with imipenem plus netilmicin for treatment of severe infections in nonneutropenic patients. Antimicrob Agents Chemother. 1994 Jun;38(6):1309-13.[Abstract][Full Text]
97. Tamma PD, Aitken SL, Bonomo RA, et al. Infectious Diseases Society of America 2022 Guidance on the treatment of extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa). Clin Infect Dis. 2022 Aug 25;75(2):187-212.[Abstract]
98. Singh N, Rogers P, Atwood CW, et al. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit: a proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med. 2000 Aug;162(2 Pt 1):505-11.[Abstract][Full Text]
99. Shan J, Chen HL, Zhu JH. Diagnostic accuracy of clinical pulmonary infection score for ventilator-associated pneumonia: a meta-analysis. Respir Care. 2011 Aug;56(8):1087-94.[Abstract][Full Text]
100. Chastre J, Wolff M, Fagon JY, et al; PneumA Trial Group. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003 Nov 19;290(19):2588-98.[Abstract][Full Text]
101. Pugh R, Grant C, Cooke RP, et al. Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults. Cochrane Database Syst Rev. 2015;(8):CD007577.[Abstract][Full Text]
102. Dimopoulos G, Poulakou G, Pneumatikos IA, et al. Short- vs long-duration antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis. Chest. 2013 Dec;144(6):1759-67.[Abstract]
103. Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs. 2019 [internet publication].[Full Text]
104. Meduri GU, Mauldin GL, Wunderink RG, et al. Causes of fever and pulmonary densities in patients with clinical manifestations of ventilator-associated pneumonia. Chest. 1994 Jul;106(1):221-35.[Abstract]
105. Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation. 2021 Apr;161:115-51.[Abstract][Full Text]
106. Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation. 2021 Apr;161:115-51.[Abstract][Full Text]
107. Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council guidelines 2021: adult advanced life support. Resuscitation. 2021 Apr;161:115-51.[Abstract][Full Text]
108. Colquhoun MC, Handley AJ, Evans TR. ABC of resuscitation. 5th ed. London: BMJ Publishing Group; 2004.
109. Chrimes N, Higgs A, Hagberg CA, et al. Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies. Anaesthesia. 2022 Dec;77(12):1395-415. [Abstract][Full Text]
110. Seppä Y, Bloigu A, Honkanen PO, et al. Severity assessment of lower respiratory tract infection in elderly patients in primary care. Arch Intern Med. 2001 Dec 10-24;161(22):2709-13.[Abstract][Full Text]
111. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002 Apr 1;165(7):867-903.[Abstract][Full Text]
112. Rubinstein E, Lalani T, Corey GR, et al. Telavancin versus vancomycin for hospital-acquired pneumonia due to gram-positive pathogens. Clin Infect Dis. 2011 Jan 1;52(1):31-40.[Abstract][Full Text]
113. Xu F, He LL, Che LQ, et al. Aerosolized antibiotics for ventilator-associated pneumonia: a pairwise and Bayesian network meta-analysis. Crit Care. 2018 Nov 15;22(1):301.[Abstract][Full Text]
114. Palmer LB, Smaldone GC, Chen JJ, et al. Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med. 2008 Jul;36(7):2008-13.[Abstract]
115. Le J, Ashley ED, Neuhauser MM, et al. Consensus summary of aerosolized antimicrobial agents: application of guideline criteria. Insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy. 2010 Jun;30(6):562-84.[Abstract]
116. Niederman MS, Alder J, Bassetti M, et al. Inhaled amikacin adjunctive to intravenous standard-of-care antibiotics in mechanically ventilated patients with Gram-negative pneumonia (INHALE): a double-blind, randomised, placebo-controlled, phase 3, superiority trial. Lancet Infect Dis. 2020 Mar;20(3):330-40.[Abstract]
117. Sotgiu G, Aliberti S, Gramegna A, et al. Efficacy and effectiveness of Ceftaroline Fosamil in patients with pneumonia: a systematic review and meta-analysis. Respir Res. 2018 Oct 23;19(1):205.[Abstract][Full Text]
118. Liapikou A, Torres A. Emerging drugs for nosocomial pneumonia. Expert Opin Emerg Drugs. 2016 Sep;21(3):331-41.[Abstract]
119. Kaye KS, Shorr AF, Wunderink RG, et al. Efficacy and safety of sulbactam-durlobactam versus colistin for the treatment of patients with serious infections caused by Acinetobacter baumannii-calcoaceticus complex: a multicentre, randomised, active-controlled, phase 3, non-inferiority clinical trial (ATTACK). Lancet Infect Dis. 2023 May 11;S1473-3099(23)00184-6.[Abstract]
120. Cook DJ, Walter SD, Cook RJ, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med. 1998 Sep 15;129(6):433-40.[Abstract]
121. Trouillet JL, Chastre J, Vuagnat A, et al. Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med. 1998 Feb;157(2):531-9.[Abstract][Full Text]
122. Westendorp WF, Vermeij JD, Zock E, et al; PASS investigators. The Preventive Antibiotics in Stroke Study (PASS): a pragmatic randomised open-label masked endpoint clinical trial. Lancet. 2015 Apr 18;385(9977):1519-26.[Abstract]
123. Aridis Pharmaceuticals, Inc. Aridis Pharmaceuticals reports positive phase 1 clinical results for Aerucin® for treating hospital-acquired and ventilator-associated pneumonia. January 2016 [internet publication].[Full Text]
124. Meng L, Wang C, Li J, Zhang J. Early vs late tracheostomy in critically ill patients: a systematic review and meta-analysis. Clin Respir J. 2016 Nov;10(6):684-92.[Abstract]
125. Terragni PP, Antonelli M, Fumagalli R, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA. 2010 Apr 21;303(15):1483-9.[Abstract][Full Text]
126. Adly A, Youssef TA, El-Begermy MM, et al. Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review. Eur Arch Otorhinolaryngol. 2018 Mar;275(3):679-90.[Abstract][Full Text]
127. Chorath K, Hoang A, Rajasekaran K, et al. Association of early vs late tracheostomy placement with pneumonia and ventilator days in critically ill patients: a meta-analysis. JAMA Otolaryngol Head Neck Surg. 2021 May 1;147(5):450-9.[Abstract][Full Text]
128. Cheung N, Betro G, Luckianow G, et al. Endotracheal intubation: the role of sterility. Surg Infect (Larchmt). 2007 Oct;8(5):545-52.[Abstract]
129. Noll DR, Degenhardt BF, Morley TF, et al. Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial. Osteopath Med Prim Care. 2010 Mar 19;4:2.[Abstract][Full Text]
130. Pozuelo-Carrascosa DP, Torres-Costoso A, Alvarez-Bueno C, et al. Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review. J Physiother. 2018 Oct;64(4):222-8.[Abstract][Full Text]
131. Tsaganos T, Raftogiannis M, Pratikaki M, et al. Clarithromycin leads to long-term survival and cost benefit in ventilator-associated pneumonia and sepsis. Antimicrob Agents Chemother. 2016 May 23;60(6):3640-6.[Abstract][Full Text]
132. Schieren M, Piekarski F, Dusse F, et al. Continuous lateral rotational therapy in trauma - a systematic review and meta-analysis. J Trauma Acute Care Surg. 2017 Nov;83(5):926-33.[Abstract]
133. Strange C, Sahn SA. The definitions and epidemiology of pleural space infection. Semin Respir Infect. 1999 Mar;14(1):3-8.[Abstract]
134. Colice GL, Curtis A, Deslauriers J, et al. Medical and surgical treatment of parapneumonic effusions : an evidence-based guideline. Chest. 2000 Oct;118(4):1158-71.[Abstract]
135. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143.[Abstract][Full Text]
136. Grohskopf LA, Blanton LH, Ferdinands JM, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices - United States, 2023-24 influenza season. MMWR Recomm Rep 2023;72(No. RR-2):1-25.[Abstract][Full Text]
