What happens if you get pneumonia in the hospital?

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

Doctors also refer to caught in a hospital as nosocomial . It's often abbreviated as HAP, for "hospital-acquired ." 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 while receiving artificial respiration.

Which bacteria play a role?

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

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

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

Apart from being the cause of an in a hospital or nursing home, multi-resistant 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 are not always effective against multi-resistant . In that case, "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 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 when they come into a hospital, for example to see if these are found in their nose or on chronic wounds. Special rules then apply during the hospital stay if 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 . 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 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.

Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP). S3-Leitlinie: Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Prävention – Update 2016. February 15, 2016.

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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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.

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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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Created on July 25, 2018
Next planned update: 2021

Authors/Publishers:

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

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