(Thai Clinical Practice Guidelines for Management …

1 4 ( 5 .. ) (Thai Clinical Practice Guidelines for Management and Prevention of Adults with Hospital-acquired and Ventilator-associated Pneumonia) 1.

2 ( Clinical Practice Guidelines ) (hospital-acquired pneumonia, HAP) (ventilator-associated pneumonia, VAP) (supportive therapy) (intensive monitoring) (evidence-based) (expert opinion) (quality of evidence)

3 (strength of recommendation) (Infectious Diseases Society of America, IDSA) (United States Public Health Service) 11

4 2 I. (hospital-acquired pneumonia, HAP) 48 1 (ventilator-associated pneumonia, VAP) 48 48 1 (healthcare-associated pneumonia, HCAP)

5 48 90 nursing home long-term care facility 30 (hemodialysis unit)1 (early-onset HAP or VAP) HAP VAP 48 4 1 (late-onset HAP or VAP) HAP VAP 4 1 > 1 > 38 1 > 2 (endotracheal tube) (orotracheal) (nasotracheal) (tracheostomy tube)

6 1 neutrophils> 25 /low-power field (LPF) squamous epithelial cells <10 /LPF3 (HCAP) (aspiration pneumonia) nursing home longterm care facility (immunocompetent adults) (human immunodeficiency virus, HIV) (hematologic malignancy)

7 (neutropenia) (transplantation) (good Clinical judgement) II. HAP VAP1-8 3 2 HAP VAP (etiologic pathogen) HAP VAP HAP VAP ( Clinical suspicion) (new onset)

8 (purulent sputum) (complete blood count, CBC) (chest X-ray) HAP VAP infiltrate (new) (progressive) 2 3.

9 ( ) . 12,000 / (12 x 109 / ) 4,000 / (4 x 109 / )1,5,8 HAP VAP 1 3 (empirical antibiotic)

10 (over diagnosis) 3 (under diagnosis) Fabregas (gold standards) HAP VAP 69 75 5 HAP VAP sepsis