Treatment of Hospital-Acquired Pneumonia and Urinary Tract Infection

HAP Treatment Algorithm

The Infectious Diseases Society of America recommends treating hospitalized patients with HAP using piperacillin-tazobactam 4.5g IV every 6 hours as the backbone antibiotic, providing broad gram-negative coverage including Pseudomonas aeruginosa, Klebsiella pneumoniae, E. coli, and methicillin-sensitive S. aureus 1, 2
The American Thoracic Society suggests adding vancomycin 15 mg/kg IV every 8-12 hours if MRSA risk factors are present, such as prior IV antibiotic use within 90 days, healthcare setting with high MRSA prevalence, prior MRSA colonization or infection, or septic shock requiring vasopressors 1, 2, 3
For patients with P. aeruginosa HAP, the Infectious Diseases Society of America recommends continuing combination therapy with two antibiotics from different classes if septic shock persists or mortality risk is high 1, 3
The American College of Chest Physicians recommends treating HAP for 7-8 days maximum if the patient responds adequately and the pathogen is not P. aeruginosa 1, 2, 3

The Infectious Diseases Society of America recommends selecting empiric antibiotics for complicated hospital-acquired UTI based on local antibiogram data and severity of illness, and avoiding the use of the same antibiotic class for both HAP and UTI to minimize resistance selection pressure 2, 3

The American Thoracic Society recommends adding vancomycin or linezolid only if documented MRSA risk factors are present, as empiric MRSA coverage without risk factors increases costs and resistance without improving outcomes 1, 2
The Infectious Diseases Society of America suggests reserving double antipseudomonal therapy for patients in septic shock, with recent antibiotic exposure, or with structural lung disease, as routine use increases toxicity without proven mortality benefit 1, 3

The American College of Chest Physicians recommends assessing clinical response at 48-72 hours using temperature, respiratory rate, heart rate, and blood pressure, and measuring C-reactive protein on days 1 and 3-4, especially in patients with unfavorable clinical parameters 2