Guideline-adherent initial intravenous antibiotic therapy for hospital-acquired/ventilator-associated pneumonia is clinically superior, saves lives and is cheaper than non guideline adherent therapy

Table 1 1a. Risk factors associated with the involvement of complicated bacterial pathogens in HAP/VAP

Risk factor	Score
Age > 65 yrs	1
Structural lung disease (e.g. COPD)	2
Previous antibiotic treatment	2
Late onset (5 or more days after admission)	3
Invasive or non-invasive mechanical ventilation on onset date	3
Extrapulmonary organ failure	4
1b. PEG therapeutic recommendations for HAP/VAP depending on the complicated pathogen risk score (CPRS)
Group I (CPRS = 1 or 2)	Aminopenicillin/BLI or cephalosporin 2/3a or quinolone 3/4 or carbapenem 2
Group II (CPRS = 3 to 5)	Acylaminopenicillin/BLI or cephalosporin 3b/4 or quinolone 2/3 or carbapenem 1
Group III (CPRS = 6 and more)	Cephalosporin 3b/4 or acylaminopenicilline/BLI or carbapenem 1
	Always in combination with either Quinolone 2/3 or aminoglycoside*

The total complicated pathogen risk score (CPRS) is calculated by adding up all individual scores for risk factors identified in a given patient.
* If the rate of MRSA among the Staphylococcus aureus infections in a given hospital is > 30%, the PEG recommends the inclusion of linezolid or vancomycin in the IIAT. According to Pletz et al., the ZEPHyR study showed that linezolid is superior to vancomycin in proven MRSA-pneumonia [32].

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