Monitoring
FURTHER EVALUATION FOR PATIENTS RESPONDING TO THERAPY
Duration of Therapy
Initial empiric therapy should be continued for 7 days. If a multidrug-resistant pathogen is identified, the patient should be treated longer, for up to 14 days.
It has been shown that patients who receive appropriate initial empiric therapy
for ventilator-associated pneumonia for 7-8 days have similar outcomes (ie mortality rate, disease
recurrence, treatment failure, length of hospital stay) to patients who have
received treatment for 10-15 days. If the given combination therapy is an aminoglycoside-containing
treatment regimen, aminoglycosides can be stopped after 5-7 days in responding
patients. The decision to discontinue antibiotic therapy should be based on
clinical evaluation plus biomarkers (eg PCT, CRP, copeptin, MR-proANP). These lessen
the duration of antibiotic exposure.
Patients with Clinical Improvement after 48-72 Hours and with
Negative Cultures
In these patients, consider discontinuing antibiotics. The decision
will depend on the clinical course of the patient, the type of sample collected,
and whether or not the reported results are quantitative or semi-quantitative.
Patients with Clinical Improvement after 48-72 Hours and with
Positive Cultures
If possible, deescalate antibiotics based on culture results.
FURTHER EVALUATION FOR PATIENTS NOT RESPONDING TO THERAPY
If patients are not responding to initial therapy or are rapidly
deteriorating, consider broadening antimicrobial coverage while cultures and
diagnostic study results are pending. These patients should be re-evaluated,
including careful differential diagnosis and repeat sampling of lower respiratory
tract secretions for culture and sensitivities, and referred to a specialist.
Patients without Clinical Improvement after 48-72 Hours and with
Negative Cultures
Evaluate for other organisms or complications. Search for other sites
of infection. Assess for other diagnoses that could be causing the symptoms.
Patients without Clinical Improvement after 48-72 Hours and with
Positive Cultures
Adjust antimicrobial therapy based on culture results. Evaluate for
other organisms or complications. Suspect drug-resistant organisms. Search for
other sites of infection. Assess for other diagnoses that could be causing the
symptoms.