What happens if I get pneumonia in the hospital?

Photo of a hospital visit

People who are in a hospital or a nursing home are often weak, and have a greater risk of complications from . Pneumonia that is caught in a hospital or in a nursing home might also be caused by different, more difficult-to-treat germs.

Pneumonia that is caught in a hospital is also known as nosocomial or hospital-acquired (HAP).

Why is there a greater risk of complications in a hospital?

Pneumonia generally doesn't lead to complications in young, otherwise healthy people. People in hospitals and retirement homes are often older, bedridden or weakened as a result of a disease or surgery. Because of this, they more frequently develop severe with complications. That risk is particularly high in patients who become infected with while on artificial respiration.

Which bacteria play a role?

Hospital-acquired is sometimes caused by germs that only rarely cause otherwise. Bacteria typically found in infections in hospitals and nursing homes include staphylococci, certain intestinal (in the bowel) such as enterococci, and uncommon like Pseudomonas aeruginosa.

These germs aren't necessarily more aggressive than other . But the key difference is that they are resistant to the that help to fight off the usual that cause .

Some are even resistant to several . Doctors call them multi-resistant or multidrug-resistant .

Which antibiotics are needed to treat hospital-acquired pneumonia?

Patients are usually first given an antibiotic drug that is known to be effective against possible hospital . But these aren't always effective against multi-resistant . In that case, certain "reserve" are used. They are the only that are still effective against those germs. Usually, combinations of different are used.

Before starting treatment, blood samples or coughed up mucus are sent to a laboratory. An antibiotic that is highly likely to be effective is then given immediately. At the same time, the tests in the laboratory find out exactly which germs are causing the . Once that is known, the antibiotic treatment is adjusted if necessary.

What can prevent pneumonia?

There are special hygiene regulations in hospitals to protect people from hospital-acquired infections. Regularly disinfecting hands is key. Cleaning and disinfecting floors and surfaces and disposing of waste is also important, though.

Certain multi-resistant germs can enter the hospital from the outside and then spread there. Because of this, patients such as residents of retirement homes are tested for multi-resistant when they first come into a hospital, for example to see if these are found in their nose or in chronic wounds. Special rules would then apply during their hospital stay. These may include being given a single room or having visitors and staff put on a mask and gown before entering the room and disinfect their hands after the visit.

Pneumonia can also be caused by “food going down the wrong way,” and bacteria from the mouth entering the lungs. That is why particularly patients in intensive care are given special assistance with oral hygiene. Some studies suggest that this can help to prevent hospital-acquired . But there were problems with many of these studies. For example, the researchers looked into very different measures, from antiseptic mouthwashes to professional teeth-cleaning.

There are other measures that are meant to prevent patients from developing during a hospital stay, such as the treatment of swallowing disorders, having patients lie with their upper body slightly raised or using antiseptic baths. But they have either hardly been studied at all, or only in patients who are on artificial respiration.

Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP). S3-Leitlinie: Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie – Update 2021. AWMF-Registernr.: 020-020. 2021.

Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63(5): e61-e111.

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Liu C, Cao Y, Lin J, Ng L, Needleman I, Walsh T et al. Oral care measures for preventing nursing home-acquired pneumonia. Cochrane Database Syst Rev 2018; (9): CD012416.

Lux LJ, Posey RE, Daniels LS, Henke DC, Durham C, Jonas DE et al. Pharmacokinetic/Pharmacodynamic Measures for Guiding Antibiotic Treatment for Hospital-Acquired Pneumonia. November 2014. (AHRQ Comparative Effectiveness Reviews; Volume 136).

National Institute for Health and Care Excellence (NICE). Pneumonia: Diagnosis and Management of Community- and Hospital-Acquired Pneumonia in Adults. December 03, 2014. (NICE Clinical Guidelines; Volume 191).

Passaro L, Harbarth S, Landelle C. Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review. Antimicrob Resist Infect Control 2016; 5: 43.

Robert Koch-Institut (RKI). Empfehlungen zur Prävention und Kontrolle von Methicillinresistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Bundesgesundheitsbl 2014; 57: 696–732.

Satheeshkumar PS, Papatheodorou S, Sonis S. Enhanced oral hygiene interventions as a risk mitigation strategy for the prevention of non-ventilator-associated pneumonia: a systematic review and meta-analysis. Br Dent J 2020; 228(8): 615-622.

Sjögren P, Wardh I, Zimmerman M, Almstahl A, Wikström M. Oral Care and Mortality in Older Adults with Pneumonia in Hospitals or Nursing Homes: Systematic Review and Meta-Analysis. J Am Geriatr Soc 2016; 64(10): 2109-2115.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on May 18, 2021

Next planned update: 2024


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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