ICU · Respiratory / ventilation

Pneumonia — CAP, HAP, VAP & Aspiration

Also known as Pneumonia · Community-acquired pneumonia · CAP · Hospital-acquired pneumonia · HAP · Ventilator-associated pneumonia · VAP · Aspiration pneumonia · CURB-65 · IDSA/ATS criteria

Pneumonia is classified by the setting of acquisition: community-acquired (CAP, outside hospital or within 48 hours of admission), hospital-acquired (HAP, after 48 hours in hospital), ventilator-associated (VAP, after 48 hours of intubation), and aspiration. The severity is graded by CURB-65, PSI, or the IDSA/ATS severe-CAP criteria. The commonest CAP pathogen is Streptococcus pneumoniae; atypicals (Mycoplasma, Legionella, Chlamydia) are also important. Late-onset HAP/VAP introduces multidrug-resistant organisms (Pseudomonas, MRSA, ESBL). The empirical antibiotics are guided by the setting, the severity, and the local antibiogram; de-escalate once the cultures identify the organism. Duration is typically 5-7 days for CAP and 7 days for VAP.