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Hospital-acquired Pneumonia
Hospital-acquired pneumonia is an infection of the lungs
contracted during a hospital stay.
Causes
Pneumonia is a very common illness. It is caused by lots
of different germs and can range in seriousness from mild
to life-threatening.
Hospital-acquired pneumonia tends to be more serious, because
a patient's defense mechanisms against infection are often
impaired during a hospital stay. In addition, the types of
germs present in a hospital are frequently more dangerous
than those encountered in the community. Hospital-acquired
pneumonia occurs more commonly in patients who require a respirator
to help them breathe. It is also known as ventilator-associated
pneumonia.
Risk factors for hospital-acquired pneumonia include:
- Alcoholism
- Being on a breathing machine
- Immunosuppression from medications or disease
- Inhaling material into the lungs
- Older age
- Recent illness
Symptoms
- Cough that may produce mucus-like, greenish, or pus-like
sputum
- Chills
- Shortness of breath
- Fever
- Easy fatigue
- Sharp or stabbing chest pain that gets worse with deep
breathing or coughing
- Headache
- Loss of appetite
- Nausea and vomiting
- General discomfort, uneasiness, or ill feeling
- Joint stiffness and joint pain (rare)
- Muscle stiffness (rare)
- Excessive sweating (rare)
Exams 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
- 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
germ detected by sputum culture. However, the organism cannot
always be identified with tests, 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 lung
treatments to loosen and remove thick secretions from the
lungs.
Outlook . . . Prognosis
Most patients respond to the treatment and improve in 2 weeks.
However, hospital-acquired pneumonia can be very severe and
sometimes deadly.
Possible Complications
Elderly or debilitated patients who fail to respond to treatment
may die from acute respiratory failure.
Prevention
Ongoing prevention programs to limit hospital-acquired infections
are in place at most institutions.
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