What happens if you get pneumonia in the hospital?

Photo of an older man (PantherMedia / meinzahn)

People who are in a hospital or a nursing home are often weak, and have a greater risk of complications from pneumonia. It's also possible that pneumonia caught in a hospital or in a nursing home is caused by different germs that are more difficult to treat.

Doctors also refer to pneumonia caught in a hospital as nosocomial pneumonia. It's often abbreviated as HAP, for "hospital-acquired pneumonia." When classifying the disease, some experts also take into consideration whether somebody became infected in a retirement or nursing home, in a medical facility such as a dialysis center, or while receiving artificial respiration.

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

Pneumonia generally has no complications in young, otherwise healthy people. People in hospitals and retirement homes are often older, bedridden or weakened as a result of disease or surgery. That is why they more frequently develop severe pneumonia with complications. That risk is particularly high in patients who become infected with pneumonia while receiving artificial respiration.

Which bacteria play a role?

Nosocomial pneumonia is triggered by germs which otherwise only rarely cause pneumonia. Bacteria typically found in infections in hospitals and nursing homes include staphylococci, certain intestinal bacteria such as enterococci, and uncommon bacteria like Pseudomonas aeruginosa.

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

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

Apart from being the cause of an infection in a hospital or nursing home, multi-resistant bacteria might be the cause if you have had antibiotics to treat another illness in recent months.

Which antibiotics are needed to treat nosocomial pneumonia?

Generally, patients are immediately given an antibiotic that is known to be effective against possible hospital germs. But these antibiotics are not always effective against multi-resistant bacteria. In that case, "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 phlegm 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 the cause. Once that is known, the antibiotic therapy is adjusted if necessary.

What can prevent infection?

There are special hygiene regulations in hospitals to protect people from nosocomial infections – especially hand disinfection. Cleaning and disinfecting floors and surfaces and disposing of waste is also important, though.

Certain multi-resistant germs can enter the hospital from outside and then spread there. That is why residents of retirement homes in need of care are tested for multi-resistant bacteria when they come into a hospital, for example to see if these bacteria are found in their nose or on chronic wounds. Special rules then apply during the hospital stay if bacteria are discovered. They 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 patients in intensive care are given special assistance with oral hygiene. Studies suggest that this can help to prevent nosocomial pneumonia. But there were problems with much of the research. 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, for example the treatment of swallowing disorders or having patients lie with their upper body slightly upright. But they have either hardly been studied at all, or are only for patients using artificial respiration.

Labels: Airways and respiratory system, Immune system and infections, J18, Multiresistant bacteria, Nosocomial infection, Pneumonia, Pneumonia