Hospital-acquired pneumonia

Definition

Hospital-acquired pneumonia is an infection of the lungs contracted during a hospital stay.

Causes, incidence, and risk factors

Pneumonia is a very common illness. It is caused by many different germs and can range in seriousness from mild to life-threatening. Hospital-acquired pneumonia tends to be more serious, because a patient's defense mechanisms against infection are often impaired during a hospital stay. In addition, the types of germs present in a hospital are frequently more dangerous than those encountered in the community.

Risk factors for hospital-acquired pneumonia include alcoholism, older age, immunosuppression from medications or disease, recent illness, and aspiration (inhaling material into the lungs).

Symptoms

• Cough that may produce mucus-like, greenish, or pus-like sputum
• Chills
• Shortness of breath
• Fever
• Easy fatigue
• Chest pain that is: 
  • Increased by deep breathing or coughing
  • Sharp or stabbing
• Headache
• Loss of appetite
• Nausea and vomiting
• General discomfort, uneasiness, or ill feeling (malaise)
• Joint stiffness and joint pain (rare)
• Muscular stiffness (rare)
• Excessive sweating (rare)

Signs and tests

A physical examination reveals respiratory distress and crackles or decreased breath sounds when listening to the chest with a stethoscope.

Tests performed may include:

• Chest x-ray or CT scan
• Sputum gram stain
• Sputum culture
• Blood cultures
• CBC (complete blood cell count)
• Arterial blood gases

Treatment

The objective of treatment is to cure the infection with antibiotics. An antibiotic is selected based on the specific germ detected by sputum culture. However, the organism cannot always be identified with tests, so antibiotic therapy is given to fight the most common bacterial organisms that infect hospitalized patients -- Staphylococcus aureus and gram-negative rods.

Supportive treatment includes supplemental oxygen and lung treatments to loosen and remove thick secretions from the lungs.

Expectations (prognosis)

Most patients respond to the treatment and improve in 2 weeks. However, hospital-acquired pneumonia can be very severe and sometimes fatal.

Complications

Elderly or debilitated patients who fail to respond to treatment may die from acute respiratory failure.

Calling your health care provider

This disorder usually develops in the hospital and is detected there.

Prevention

Ongoing prevention programs to limit hospital-acquired infections are in place at most institutions.

Illustrations

Hospital-acquired pneumonia

Respiratory system

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Nosocomial pneumonia ; nosocomial pneumonia; nosocomial pneumonia treatment