Causes

Pneumonia is a very common illness. It is caused by many different germs, and the infection can range in seriousness from mild to life-threatening.

Hospital-acquired pneumonia tends to be more serious than other lung infections, because:

• Patients in the hospital are often sicker and unable to fight off germs.
• The types of germs present in a hospital are often more dangerous than those encountered in the community.

Hospital-acquired pneumonia occurs more often in patients who are using a respirator machine (also called a ventilator) to help them breathe. When pneumonia occurs in a patient who is on a ventilator, it is known as ventilator-associated pneumonia.

Risk factors for hospital-acquired pneumonia include:

• Alcoholism
• Being on a breathing machine
• Breathing saliva or food into the lungs (aspiration)
• Chest surgery
• Immunosuppression (immune system does not work well)
• Long-term (chronic) lung disease
• Not being fully alert
• Older age
• Recent illness

Symptoms

• Cough that may produce mucus-like, greenish, or pus-like phlegm (sputum)
• Chills
• Easy fatigue
• Excessive sweating (rare)
• Fever
• General discomfort, uneasiness, or ill feeling (malaise)
• Headache
• Joint stiffness and pain (rare)
• Loss of appetite
• Muscle stiffness (rare)
• Nausea and vomiting
• Sharp or stabbing chest pain that gets worse with deep breathing or coughing
• Shortness of breath

Exams and Tests

A physical examination shows:

• Crackles or decreased breath sounds when listening to the chest with a stethoscope
• Decreased oxygen
• Respiratory distress

Tests performed may include:

• Arterial blood gases
• Blood cultures
• Chest x-ray or CT scan
• Complete blood count (CBC)
• Sputum culture
• Sputum gram stain

Treatment

Treatment aims to cure the infection with antibiotics. An antibiotic is chosen based on the specific germ found by sputum culture.

However, the bacteria cannot always be identified with tests. Antibiotic therapy is given to fight the most common bacteria that infect hospitalized patients, taking into account the most common bacteria in each hospital -- Staphylococcus aureus and gram-negative bacteria.

Supportive treatment includes:

• Oxygen
• Lung treatments to loosen and remove thick mucus from the lungs

Outlook (Prognosis)

Most patients respond to treatment and improve within 2 weeks. However, hospital-acquired pneumonia can be very severe and sometimes life-threatening.

Patients who also have many other serious conditions do not do as well.

Possible Complications

Elderly or very weak patients who do not respond to treatment may die from acute respiratory failure caused by the pneumonia.

Prevention

Ongoing prevention programs to limit hospital-acquired infections are in place at most institutions.

Alternative Names

Nosocomial pneumonia; Ventilator-associated pneumonia; Health-care associated pneumonia

References

American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416.

Craven DE, Chroneou A. Nosocomial pneumonia. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 303.

Chastre J, Luyt CE. Ventilator-associated pneumonia. In: Mason RJ, Broaddus VC, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 33.

Update Date: 2/19/2012

Reviewed by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, Unviersity of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.