Suspected HAP
Pneumonia ≥48h after hospital admission
All Pathways
Internal MedicineManagement
Hospital-Acquired Pneumonia Management (IDSA/ATS 2016)
Hospital-Acquired Pneumonia Management (IDSA/ATS 2016): Suspected HAP → Confirm Diagnosis → Assess MDR Risk Factors → Low MDR Risk → MRSA Risk Factors?.
Pathway Overview
12 steps
Algorithm Steps
12 total
01Start 02Action Confirm Diagnosis
Clinical + radiographic criteria
- New/progressive infiltrate on CXR
- Plus ≥2: fever, leukocytosis/leukopenia
- Purulent secretions, declining oxygenation
- Obtain respiratory cultures (sputum or BAL)
- Blood cultures x2
03Decision Assess MDR Risk Factors
Determine coverage needed
- IV antibiotics in prior 90 days
- High local resistance (>10-20%)
- Structural lung disease
- Prior MDR isolation
- Hospitalization ≥5 days
04Action Low MDR Risk
Standard coverage
- Piperacillin-tazobactam, OR
- Cefepime, OR
- Levofloxacin, OR
- Imipenem or meropenem
05Decision MRSA Risk Factors?
Prior MRSA, high local MRSA, severe illness
- Prior MRSA colonization/infection
- IV antibiotics in prior 90 days
- High MRSA prevalence unit (>10-20%)
- Consider if unknown
06Action Add MRSA Coverage
Vancomycin or linezolid
- Vancomycin: trough 15-20 mg/L
- Linezolid: 600mg IV q12h
- Linezolid may be preferred in renal impairment
07Decision Reassess at 48-72h
Review cultures, clinical response
- Review culture results
- De-escalate if possible
- Assess clinical improvement
- Consider broadening if deteriorating
08Action De-escalate Therapy
Narrow based on cultures
- Target identified pathogen(s)
- Switch to narrowest effective agent
- Consider PO switch if improving
- Stop MRSA coverage if cultures negative
09Outcome Treatment Duration
7 days recommended for uncomplicated HAP
- 7 days: standard duration
- Consider shorter if rapid improvement
- Longer if: Pseudomonas, abscess, empyema
- Serial procalcitonin may guide
10Warning No Clinical Improvement
Consider alternative diagnoses
- Repeat imaging
- Consider bronchoscopy/BAL
- Evaluate for empyema, abscess
- Consider non-infectious causes
- ID consultation
11Action No MRSA Coverage
Gram-negative focused
- Path rejoins step 07Shared downstream outcome
12Action High MDR Risk
Double gram-negative + MRSA coverage
- Anti-pseudomonal beta-lactam
- PLUS second anti-pseudomonal agent
- (aminoglycoside OR fluoroquinolone)
- PLUS MRSA coverage if risk factors
- Path rejoins step 05Shared downstream outcome
Guideline Source
IDSA/ATS Guidelines for Management of HAP and VAP
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not cover VAP in detail (see separate algorithm)
- Local antibiogram should guide empiric therapy
- Immunocompromised patients may need broader coverage
- Drug dosing not included - refer to protocols
- Does not replace ID consultation for MDR organisms
Contraindicated Populations
immunocompromised_severe
Applicable Regions
USEU
EU: ERS/ESICM guidelines similar
US: Based on IDSA/ATS 2016 guidelines
Version 1Next review: 2027-01-01
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Related Resources
Frequently Asked Questions
What is the Hospital-Acquired Pneumonia Management (IDSA/ATS 2016)?
The Hospital-Acquired Pneumonia Management (IDSA/ATS 2016) is a management clinical algorithm for Internal Medicine. It provides a structured decision tree to guide clinical decision-making, based on IDSA/ATS Guidelines for Management of HAP and VAP.
What guideline is the Hospital-Acquired Pneumonia Management (IDSA/ATS 2016) based on?
This algorithm is based on IDSA/ATS Guidelines for Management of HAP and VAP (DOI: 10.1093/cid/ciw353).
What are the limitations of the Hospital-Acquired Pneumonia Management (IDSA/ATS 2016)?
Known limitations include: Does not cover VAP in detail (see separate algorithm); Local antibiogram should guide empiric therapy; Immunocompromised patients may need broader coverage; Drug dosing not included - refer to protocols; Does not replace ID consultation for MDR organisms. Individual patient factors may require deviation from these recommendations.
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