Nosocomial pneumonia is the second most common hospital-acquired infection, after urinary tract infection; however, it carries with it a mortality rate estimated to be between 20% and 50%. Furthermore, patients with nosocomial pneumonia are hospitalized for an additional 7 to 9 days with an attributable cost of $40 000 or more per patient compared to patients without nosocomial pneumonia. While treatment options vary, initial empiric treatment of nosocomial pneumonia should include antimicrobials that will have activity against the organisms that will likely be encountered, including, but not limited to, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter species, Klebsiella pneumoniae, Enterobacter subspecies, Serratia marcescens, and Stenotrophomonas maltophilia. During a time of increasing resistance, it is crucial that early recognition along with appropriate treatment and dosing strategies are employed to achieve successful outcomes. The goal of this article is to update clinicians about nosocomial pneumonia and provide information regarding caveats to selecting and dosing antimicrobials, so informed decisions can be made when treating this serious condition.
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