What happens if you get pneumonia in the hospital?

Pneumonia generally doesn't lead to complications in young, otherwise healthy people. People in hospitals and nursing homes are often older, bedridden or weakened as a result of a disease or surgery. Because of this, they are more likely to develop severe pneumonia with complications – like lasting weakness or getting too little oxygen. That risk is particularly high in patients who become infected with pneumonia while receiving artificial ventilation (breathing support).

Hospital-acquired pneumonia is sometimes caused by germs that only rarely cause pneumonia otherwise. Bacteria typically found in hospitals and nursing homes include staphylococcus, various intestinal (bowel) bacteria like enterococcus, or certain non-typical 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 that help to fight off the usual bacteria that cause pneumonia. Then the antibiotics don't work.

Some bacteria are even resistant to several different types of antibiotics. They are called multi-resistant or multidrug-resistant bacteria.

Patients are usually first given an antibiotic drug that is known to be effective against possible hospital bacteria too. But these antibiotics aren't always effective against multi-resistant bacteria. In that case, certain "reserve" (last-resort) 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, tests in the laboratory find out exactly which germs are causing the pneumonia. Once that is known, the treatment with antibiotics 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 outside, too, 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 they have these bacteria in their nose or in chronic wounds. Then special rules apply during their hospital stay: They are given a single room, for instance. Visitors and hospital staff put on a protective gown and mask before entering the room, and they also disinfect their hands after every visit.

Pneumonia can also develop if contents of the mouth go down the wrong way, and bacteria from the mouth enter the lungs. For this reason, 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.