What happens if I get pneumonia in the 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 pneumonia with complications. That risk is particularly high in patients who become infected with pneumonia while on artificial respiration.

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

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

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

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

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 bacteria when they first come into a hospital, for example to see if these bacteria 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 pneumonia. 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 pneumonia 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.