Hailey Tran
Hospital-acquired pneumonia (HAP) is a severe lung infection that occurs during a hospital stay. It is often more serious than pneumonia acquired outside of the hospital due to the patient's weakened state and the presence of more dangerous, treatment-resistant germs in a hospital environment. The most common cause of HAP is the microaspiration of bacteria that colonize the oropharynx and upper airways, and to some extent, the upper gastrointestinal tract in seriously ill patients. HAP can be difficult to diagnose, especially in older adults, those with breathing tubes, those with dementia, and those who are critically ill, as they may be unable to describe symptoms such as chest pain, shortness of breath, and weakness.
| Characteristics | Values |
|---|---|
| Definition | Pneumonia is a common lung infection caused by bacteria, viruses or fungi. |
| Hospital-acquired pneumonia definition | Pneumonia that develops at least 48 hours after hospital admission in patients not receiving mechanical ventilation. |
| Cause | The most common cause of hospital-acquired pneumonia is the microaspiration of bacteria that colonize the oropharynx and upper airways, and to some extent the upper gastrointestinal tract, in seriously ill patients. |
| Risk factors | Older age, depressed consciousness, aspiration, previous antibiotic treatment, high gastric pH, structural lung disease, colonisation with MDR pathogens, high local hospital prevalence of pathogens, high-dose corticosteroids, chronic suppurative lung diseases, immunocompetence, immunocompromise, smoking, other infections or health conditions, age, breathing tubes, dementia, critical illness. |
| Prevention | Vaccination, healthy habits, quitting smoking, avoiding secondhand smoke, washing hands, avoiding close contact and sharing items with people with infectious diseases, healthy diet, exercise, rest, treating other infections. |
| Diagnosis | Symptoms include fever, an increase in respiratory rate and heart rate, malaise, chills, rigor, cough, dyspnea, chest pain, confusion, loss of appetite, restlessness, agitation, falling, incontinence. Diagnostic tools include chest x-ray, chest CT scan, blood sample, bronchoscopy, thoracentesis, bronchoalveolar lavage. |
| Treatment | Initial empiric antibiotic therapy, antimicrobial therapy, culture of a potential pathogen from pleural fluid or blood. |
What You'll Learn
- Hospital-acquired pneumonia is an infection of the lungs that occurs during a hospital stay
- Risk factors include older age, depressed consciousness, previous antibiotic treatment, and high gastric pH
- The most common cause is microaspiration of bacteria that colonise the oropharynx and upper airways
- Ventilator-associated pneumonia is a type of hospital-acquired pneumonia
- Diagnosis is difficult, and treatment should be based on the local profile of organisms associated with hospital-acquired pneumonia
Hospital-acquired pneumonia is an infection of the lungs that occurs during a hospital stay
Hospital-acquired pneumonia typically develops at least 48 hours after hospital admission in patients who are not receiving mechanical ventilation. The most common cause is the microaspiration of bacteria that colonise the oropharynx and upper airways, and to a lesser extent, the upper gastrointestinal tract. Less common causes include the seeding of the lungs due to bacteremia or the inhalation of contaminated aerosols containing certain species of Legionella, Aspergillus, or the influenza virus.
Risk factors for hospital-acquired pneumonia include older age, depressed consciousness, aspiration, previous antibiotic treatment, and high gastric pH. Patients who require mechanical ventilation or breathing machines are also at greater risk. Organisms that do not typically cause pneumonia in healthy individuals can cause pneumonia in hospitalised patients with weakened immune systems.
The diagnosis of hospital-acquired pneumonia is based on symptoms such as fever, chest pain, shortness of breath, and an increased respiratory and heart rate. Doctors may also rely on chest x-rays or CT scans to confirm the diagnosis. Treatment involves empiric antimicrobial therapy based on the local profile of organisms associated with hospital-acquired pneumonia.
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Risk factors include older age, depressed consciousness, previous antibiotic treatment, and high gastric pH
Hospital-acquired pneumonia is a lung infection that occurs during a hospital stay. It is often more severe than pneumonia acquired outside of the hospital, and can sometimes be fatal. This is because hospitalised patients are often already very sick and their immune systems are compromised, making it harder for them to fight off germs. The types of germs found in hospitals are also often more resistant to treatment.
Pneumonia is caused by bacteria, viruses, or fungi. Hospital-acquired pneumonia is usually caused by microaspiration of bacteria that colonise the oropharynx and upper airways, and to some extent, the upper gastrointestinal tract. Less common causes include the inhalation of contaminated aerosols containing Legionella, Aspergillus, or influenza virus.
Risk factors for hospital-acquired pneumonia include older age, depressed consciousness, previous antibiotic treatment, and high gastric pH. Older adults with pneumonia may experience confusion, loss of appetite, restlessness, agitation, falling, and incontinence. Depressed consciousness in patients with pneumonia may be indicated by symptoms such as fever, an increased respiratory rate, and an elevated heart rate.
Previous antibiotic treatment within the previous 90 days is a risk factor for infection with multidrug-resistant (MDR) pathogens. This is because antibiotics can alter the balance of microorganisms in the body, allowing antibiotic-resistant organisms to thrive. High gastric pH, on the other hand, is often a result of stress ulcer prophylaxis or treatment with proton pump inhibitors. This alters the acidity of the stomach, making it more favourable for the growth of certain bacteria that can cause pneumonia.
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The most common cause is microaspiration of bacteria that colonise the oropharynx and upper airways
Hospital-acquired pneumonia is an infection of the lungs that occurs during a hospital stay. It can be very severe and is sometimes fatal. The infection is usually more serious than other lung infections because hospitalised patients are often already very sick and unable to fight off germs effectively. The types of germs present in hospitals are also often more dangerous and resistant to treatment than those found in the community.
The most common cause of hospital-acquired pneumonia is microaspiration of bacteria that colonise the oropharynx and upper airways. The oropharynx is the part of the throat at the back of the mouth, including the soft palate and the base of the tongue. It is a favourable environment for many different types of bacteria, including Streptococcus infantis, Streptococcus mitis, and Streptococcus aureus. These bacteria can then be aspirated into the lungs, causing infection.
The risk of microaspiration is particularly high for patients on ventilators or who have recently had surgery. This is because the act of breathing deeply and moving around helps to keep the lungs open and prevent infection. Additionally, the very nature of mechanical ventilation can introduce bacteria into the lungs. Patients who are seriously ill or have a depressed level of consciousness are also at a higher risk of microaspiration, as they may not be able to effectively clear their airways.
The upper airways and oropharynx are usually well-defended against bacterial colonisation. However, certain viruses, such as influenza A and B, respiratory syncytial virus, and human rhinovirus, can disrupt the upper respiratory tract microbiota and allow bacteria to take hold. This is particularly dangerous for hospitalised patients, who are already at an increased risk of infection.
Hospital-acquired pneumonia can be difficult to diagnose and treat. Prevention is therefore crucial, and most hospitals have programs in place to prevent hospital-acquired infections. Patients should also follow their doctor's advice to help prevent pneumonia, such as taking deep breaths and moving around after surgery.
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Ventilator-associated pneumonia is a type of hospital-acquired pneumonia
Hospital-acquired pneumonia is an infection of the lungs that occurs during a hospital stay. This type of pneumonia can be very severe and sometimes fatal. Pneumonia is a common illness caused by many different germs. It tends to be more serious when contracted in a hospital because patients are often already very sick and unable to fight off germs. The germs present in hospitals are also often more dangerous and resistant to treatment than those outside the community.
Ventilator-associated pneumonia (VAP) is a type of hospital-acquired pneumonia. It occurs in patients who have been using a ventilator, a machine that helps them breathe. VAP is defined as pneumonia that presents more than 48 hours after endotracheal intubation. The intubation and ventilatory support bypass the normal host defense mechanisms, predisposing patients to infection. Organisms associated with VAP include Legionella, Influenza A, RSV, hMPV, and HPIV-3.
The risk factors for VAP include older age, depressed consciousness, aspiration, previous antibiotic treatment, and high gastric pH. The use of high-dose corticosteroids also increases the risk of VAP. The mortality rate for VAP is estimated to be around 13%, and patients with VAP face longer hospital stays and higher healthcare costs.
The diagnosis of VAP is challenging, especially in intensive care units, due to the complex conditions of critically ill patients. Non-invasive tests such as blood and sputum cultures and staphylococcal nasal swabs can help identify the culprit organism and guide antibiotic therapy. However, the recovery of a respiratory pathogen from respiratory secretions does not necessarily establish it as the cause of VAP.
Hospitals have implemented programs to prevent hospital-acquired infections, including respiratory hygiene measures such as hand hygiene and the use of masks or tissues for patients with a cough. Timely vaccinations for both patients and healthcare providers can also help reduce the transmission of respiratory pathogens.
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Diagnosis is difficult, and treatment should be based on the local profile of organisms associated with hospital-acquired pneumonia
Hospital-acquired pneumonia (HAP) is a lung infection that occurs during a hospital stay. HAP is a serious condition that can sometimes be fatal. It is considered the most common cause of hospital-acquired infections in Europe and the United States, with a rate of 5 to 10 per 1000 hospital admissions.
HAP is defined as pneumonia that occurs 48 hours or more after hospital admission and is not present at the time of admission. The most common cause of HAP is microaspiration of bacteria that colonize the oropharynx and upper airways, as well as the upper gastrointestinal tract, in seriously ill patients. Other causes include seeding of the lungs due to bacteremia or inhalation of contaminated aerosols containing Legionella species, Aspergillus species, or the influenza virus. Risk factors for HAP include older age, depressed consciousness, aspiration, previous antibiotic treatment, and high gastric pH.
Diagnosis of HAP is challenging and controversial, with no superior method currently available. The specific pathogen causing HAP is often unknown, further complicating diagnosis and treatment. The most specific finding is the culture of a potential pathogen from pleural fluid or blood. Treatment should be based on the local profile of organisms associated with HAP and their antibiotic sensitivities. Initial empiric antibiotic therapy may be necessary, especially against antibiotic-resistant organisms. High-quality specimens and cultures are crucial for identifying the causative pathogens and guiding treatment decisions.
The management of HAP requires an interprofessional team of specialists, including infectious disease experts, pulmonary disease specialists, critical care providers, anesthesiologists, nurses, and pharmacists. Proper management is essential to prevent high morbidity and mortality associated with HAP. The duration of antibiotic therapy for HAP is typically 7 to 14 days, with shorter durations of 7 days being effective in limiting the emergence of resistant organisms.
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Frequently asked questions
Hospital-acquired pneumonia is a lung infection that occurs during a hospital stay. It is often more severe and sometimes fatal. This is because patients are often already very ill and cannot fight off germs. The germs that cause hospital-acquired pneumonia are also more dangerous and resistant to treatment than those outside the hospital.
Hospital-acquired pneumonia is usually caused by microaspiration of bacteria that colonize the oropharynx and upper airways, and to some extent the upper gastrointestinal tract, in seriously ill patients. It can also be caused by seeding of the lungs due to bacteremia or inhalation of contaminated aerosols. Risk factors include older age, depressed consciousness, previous antibiotic treatment, and high gastric pH.
Hospital-acquired pneumonia is treated with empiric antimicrobial therapy, based on the local profile of organisms associated with the infection and their antibiotic sensitivities. Doctors may also perform bronchoscopy to obtain specimens from within the lung itself to identify the organism causing the infection.
