Pneumonia. CAP and VAP simultaneously?

[LunaTuna]

Hi so I'm working on an assignment after my clinical rotation in the ICU. This patient was admitted with acute hypoxic respiratory failure due to CAP and influenza B. The patient also had severe DKA from recently diagnosed DM type 2 and they developed acute renal failure while in the hospital. This patient has a poor prognosis and has been intubated for about a week now.

I know that being on a ventilator there is a big risk of developing VAP. My question is that can a patient have CAP and VAP at the same time? My guess is yes as they could have two different strains of pneumonia, but does the CAP increase the patients risk of developing VAP?

[mrsboots87]

Sure, theoretically they probably could. But when the patient is already diagnosed with pneumonia, I don't see why the hospital would test specifically for what types of organisms outside of the antibiotic not being effective.

Where I work, sputum is not routinely tested in PNA diagnosis. Usually just a CXR is ordered when a patient is symptomatic and the diagnosis is made from that. Sputum is tested for sensitivity only when the first line antibiotics are not effective.