ICU · Antimicrobial Stewardship

Ventilator-associated pneumonia (VAP)

Also known as Ventilator-associated pneumonia (VAP) · Hospital-acquired pneumonia (HAP) · CPIS (Clinical Pulmonary Infection Score) · VAP prevention bundle

VAP is pneumonia developing more than 48 hours after endotracheal intubation. It is one of the most frequent ICU-acquired infections, with attributable mortality of around 10 percent. Pathogenesis: microaspiration of oropharyngeal secretions around the ETT cuff, bacterial colonisation of the ETT biofilm. Diagnosis: new/persistent infiltrate on CXR PLUS at least 2 of fever, leukocytosis, purulent secretions, with CPIS as a support tool. Microbiology: early VAP (under 5 days) — S. pneumoniae, H. influenzae, MSSA. Late VAP (5 days or more) — MRSA, Pseudomonas, Acinetobacter, ESBL. Treatment: empiric antibiotics promptly, guided by MDR risk, de-escalate when susceptibility results return. Duration: 7 days standard (8 vs 15 day trial). Prevention bundle: head elevation 30-45 degrees, daily sedation interruption, oral care, subglottic suction, cuff pressure control.