318 Ch 317. Hospital-Acquired and Ventilator-Associated Pneumonia (HAP/VAP)

HAP = 入院 ≥ 48 小時後發生的肺炎；VAP = 機械通氣 ≥ 48 小時後發生；HCAP category 已 retired（IDSA/ATS 2016, 2019）；MDR (multidrug-resistant) risk factors：(1) recent IV antibiotics within 90 days；(2) septic shock at presentation；(3) ARDS preceding；(4) prolonged hospitalization (≥ 5 days)；(5) MRSA / Pseudomonas colonization；(6) immunocompromise；common pathogens：Pseudomonas、MRSA、Acinetobacter、ESBL Enterobacteriaceae、Stenotrophomonas、Burkholderia；empiric therapy：(1) Pseudomonas-active β-lactam (pip-tazo, cefepime, meropenem) + (2) MRSA cover (vanc, linezolid) + (3) consider 2nd anti-Pseudomonas (AG, ciprofloxacin) if high MDR risk；de-escalate per cultures；duration: 7 days for most (PneumA — non-Pseudomonas) — even shorter than older 14-21 day recommendations；VAP prevention bundle：head of bed 30-45°、daily SAT/SBT、oral chlorhexidine (controversial 2024)、early ambulation、subglottic suction、PUD prophylaxis；2024 trends：cefiderocol、ceftolozane-tazobactam、meropenem-vaborbactam、imipenem-relebactam for MDR；procalcitonin stewardship。