Suspected HAP/VAP
New infiltrate + fever/WBC/purulent secretions ≥48h after admission
All Pathways
Infectious DiseaseManagement
Hospital-Acquired & Ventilator-Associated Pneumonia (ATS/IDSA 2016)
Hospital-Acquired & Ventilator-Associated Pneumonia (ATS/IDSA 2016): Suspected HAP/VAP → Diagnostic Workup → MDR Risk Factors? → Low MDR Risk → MRSA Risk?.
Pathway Overview
11 steps
Algorithm Steps
11 total
01Start 02Action Diagnostic Workup
Respiratory cultures before antibiotics
- Endotracheal aspirate (VAP) or sputum (HAP)
- Blood cultures x2
- Consider bronchoscopy with BAL if available
03Decision MDR Risk Factors?
Prior 90d IV antibiotics, septic shock, ARDS, ≥5d hospitalization, prior MDR
04Action Low MDR Risk
Standard coverage
- Pip-tazo 4.5g IV q6h, OR
- Cefepime 2g IV q8h, OR
- Levofloxacin 750mg IV daily, OR
- Meropenem 1g IV q8h
05Decision MRSA Risk?
Prior MRSA, high local prevalence, severe illness
06Action Add MRSA Coverage
Vancomycin or Linezolid
- Vancomycin 15-20mg/kg IV q8-12h (target trough 15-20)
- OR Linezolid 600mg IV q12h
07Action De-escalate at 48-72h
Based on cultures and clinical response
- Narrow to targeted therapy
- Stop MRSA/double coverage if cultures negative
- Procalcitonin may guide duration
08Action Duration: 7 Days
Short course for most HAP/VAP
- 7 days for uncomplicated
- May extend if immunocompromised, slow response, or MDR
09Outcome Resolved
10Warning Treatment Failure
Broaden, repeat cultures, consider other dx
- Path rejoins step 07Shared downstream outcome
11Action High MDR Risk
Dual antipseudomonal + MRSA coverage
- Two antipseudomonal agents from different classes:
- Pip-tazo/Cefepime/Meropenem + Aminoglycoside/FQ
- PLUS Vancomycin or Linezolid for MRSA
- Path rejoins step 05Shared downstream outcome
Guideline Source
ATS/IDSA HAP/VAP Guidelines 2016
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- ⚠️ UNVALIDATED DRAFT: This algorithm was AI-generated from guideline summaries and has NOT been reviewed by clinical experts. All doses, thresholds, and pathways MUST be verified against primary sources by qualified clinicians before clinical use. Do not use for patient care without expert validation.
- Local antibiogram critical
- MDR risk assessment varies
- Quantitative cultures not universally available
Applicable Regions
USEU
Version 1Next review: 2027-01-11
Next steps
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Related Resources
Frequently Asked Questions
What is the Hospital-Acquired & Ventilator-Associated Pneumonia (ATS/IDSA 2016)?
The Hospital-Acquired & Ventilator-Associated Pneumonia (ATS/IDSA 2016) is a management clinical algorithm for Infectious Disease. It provides a structured decision tree to guide clinical decision-making, based on ATS/IDSA HAP/VAP Guidelines 2016.
What guideline is the Hospital-Acquired & Ventilator-Associated Pneumonia (ATS/IDSA 2016) based on?
This algorithm is based on ATS/IDSA HAP/VAP Guidelines 2016 (DOI: 10.1093/cid/ciw353).
What are the limitations of the Hospital-Acquired & Ventilator-Associated Pneumonia (ATS/IDSA 2016)?
Known limitations include: ⚠️ UNVALIDATED DRAFT: This algorithm was AI-generated from guideline summaries and has NOT been reviewed by clinical experts. All doses, thresholds, and pathways MUST be verified against primary sources by qualified clinicians before clinical use. Do not use for patient care without expert validation.; Local antibiogram critical; MDR risk assessment varies; Quantitative cultures not universally available. Individual patient factors may require deviation from these recommendations.
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