The American Thoracic Society (ATS) provided a strategy for managing an adult with suspected healthcare-associated pneumonia.
Healthcare-associated pneumonia includes hospital-acquired and ventilator-associated pneumonias.
If a healthcare-associated pneumonia is suspected:
(1) collect an optimum lower respiratory tract specimen for culture and microscopy
(2) start empiric antimicrobial therapy after collecting culture specimens (exception: low clinical suspicion of pneumonia AND negative microscopy of lower respiratory tract specimen)
After 48-72 hours re-evaluate the patient with review of chest imaging studies, cultures and clinical condition.
Parameters:
(1) clinical improvement at 48-72 hours
(2) culture results
Clinical Improvement
Culture Status
Management
yes
positive
de-escalate antibiotics if possible; treat selected patients for 7-8 days and reassess
negative
consider stopping antibiotics
no
adjust antibiotic regimen; search for other pathogens; look for other sites of infection; consider other diagnoses; consider complications
search for other pathogens; look for other sites of infection; consider other diagnoses; consider complications
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Specialty: Infectious Diseases
