Ventilator-associated pneumonia

Background

Definition

• Pneumonia that develops at least 48 hours after starting invasive ventilation

Microbiology

• Early (within 4 days)
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Methicillin-susceptible Staphylococcus aureus
  • Enteric Gram-negative bacilli
  • Escherichia coli
  • Klebsiella pneumoniae
  • Enterobacter
  • Proteus
  • Serratia marcescens
• Late (after 4 days)
  • Methicillin-resistant Staphylococcus aureus
  • Acinetobacter
  • Pseudomonas aeruginosa
  • ESBL bacteria

Clinical Manifestations

• Intubation
• Fever, leukocytosis, purulent secretions

Investigations

• Chest x-ray
• Sputum culture

Diagnosis

• Clinical Pulmonary Infection Score