Ventilator-associated pneumonia: Risk factors for multidrug-resistance in adults

Risk factors for MDR pathogens (including Pseudomonas aeruginosa, other gram-negative bacilli, and MRSA):

IV antibiotic use within the previous 90 days
Septic shock at the time of VAP
ARDS preceding VAP
≥5 days of hospitalization prior to the occurrence of VAP
Acute renal replacement therapy prior to VAP onset

Risk factors for MDR Pseudomonas and other gram-negative bacilli:

Treatment in an ICU in which >10% of gram-negative isolates are resistant to an agent being considered for monotherapy
Treatment in an ICU in which local antimicrobial susceptibility rates are not known
Colonization with or prior isolation of MDR Pseudomonas or other gram-negative bacilli on culture from any body site

Risk factors for MRSA:

Treatment in an ICU in which >10 to 20% of Staphylococcus aureus isolates are methicillin resistant
Treatment in an ICU in which the prevalence of MRSA is not known
Colonization with or prior isolation of MRSA on culture from any body site

MDR: multidrug resistant; IV: intravenous; VAP: ventilator-associated pneumonia; ARDS: acute respiratory distress syndrome; ICU: intensive care unit; MRSA: methicillin-resistant S. aureus; ICU: intensive care unit.

Adapted from: Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63:e61.

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Ventilator-associated pneumonia: Risk factors for multidrug-resistance in adults