Nosocomial pneumonia

Alternative names
Hospital-acquired pneumonia

Definition
Hospital-acquired pneumonia is an infection of the lungs contracted during a hospital stay.

Causes, incidence, and risk factors

Pneumonia is a very common illness. It is caused by many different organisms and can range in seriousness from mild to life-threatening. Hospital-acquired pneumonia tends to be more serious because defense mechanisms against infection are often impaired during a hospital stay, and the kinds of infecting organisms are more dangerous than those generally encountered in the community.

Risk factors predisposing people to hospital-acquired pneumonia are alcoholism, older age, immunosuppression from medications or diseases, recent illness, and risk of aspiration.

Symptoms

     
  • cough       o may produce mucus-like, greenish, or pus-like sputum  
  • chills  
  • shortness of breath  
  • fever  
  • easy fatigue  
  • chest pain       o increased by deep breathing or coughing       o sharp or stabbing  
  • headache  
  • loss of appetite  
  • nausea and vomiting  
  • general discomfort, uneasiness, or ill feeling (malaise)  
  • joint stiffness and joint pain (rare)  
  • muscular stiffness (rare)  
  • excessive sweating (rare)

Signs and tests

A physical examination reveals respiratory distress and crackles or decreased breath sounds when listening to the chest with a stethoscope.

Tests performed may include:

     
  • chest x-ray or CT scan  
  • sputum Gram stain  
  • sputum culture to determine causative organism  
  • blood cultures  
  • CBC (complete blood cell count)  
  • arterial blood gases

Treatment

The objective of treatment is to cure the infection with antibiotics. An antibiotic is selected based on the specific causative organism detected by sputum culture. However, the organism cannot always be identified from testing, so antibiotic therapy is given to fight the most common bacterial organisms that infect hospitalized patients (Staphylococcus aureus and Gram negative rods).

Supportive treatment includes supplemental oxygen and respiratory treatments to loosen and remove thick secretions from the lungs.

Expectations (prognosis)

Most patients respond to the treatment and improve in 2 weeks. However, hospital-acquired pneumonias can be very severe and sometimes fatal.

Complications

Elderly or debilitated patients who fail to respond to treatment may die from acute respiratory failure.

Calling your health care provider

This disorder usually develops in the hospital and is detected there.

Prevention

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

Johns Hopkins patient information

Last revised: December 8, 2012
by Brenda A. Kuper, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.