Hospital acquired pneumonia in adults
Nosocomial pneumonia develops in patients in hospitals, especially in intensive care units and intensive care units. These are very dangerous diseases, their mortality rate is from 20 to 80%.

Nosocomial pneumonia occurs in approximately 1% of patients undergoing long-term treatment in hospitals. The risk is especially high in people who require mechanical ventilation, prolonged immobility, or major surgery.

What is Hospital Acquired Pneumonia

Hospital-acquired or nosocomial (another name is nosocomial) pneumonia is an inflammation of the lungs that occurs during hospital treatment as a complication.

In order for pneumonia to be considered hospital-acquired, it should appear no earlier than 2 days after the patient was admitted to the clinic. In addition, a key characteristic of this type of pneumonia is pathogens. Inflammation is caused by the so-called nosocomial, multidrug-resistant flora.

Hospital-acquired pneumonias are among the three most common complications of inpatient treatment, with only suppuration of wounds and inflammation of the urinary tract occurring more frequently.

Causes of hospital-acquired pneumonia in adults

The main provocateurs of hospital-acquired pneumonia are gram-negative bacteria living in the walls of hospitals. These are Klebsiella, Pseudomonas aeruginosa, Proteus, Serrations or Escherichia coli. They account for up to 30% of all pneumonias.

Almost a third of this type of pneumonia is caused by aggressive nosocomial types of Staphylococcus aureus. Another 30% of pneumonia is caused by fusobacteria and bacteroids (anaerobic bacteria). About 4% of all hospital-acquired pneumonias are caused by legionella, a bacteria that can cause outbreaks if it multiplies in the ventilation system and spreads throughout the hospital.

Much less often, in about 1% of cases, hospital-acquired viral pneumonia occurs. The most common pathogens are influenza viruses, RS virus and, in some cases, cytomegalovirus.

Key risk factors for developing hospital-acquired pneumonia:

  • long stay in the hospital;
  • bed rest, when the patient is practically unable to move;
  • too frequent and prolonged use of antibiotics without strict indications;
  • elderly age;
  • a serious condition of the patient associated with circulatory disorders, extensive surgical interventions, blood loss or trauma, shock;
  • sharply suppressed immunity.

In addition, the risk of developing pneumonia after certain medical procedures increases – bronchoscopy and breathing through a tracheostomy, being on a ventilator (every day increases the risk by 1%), frequent vomiting in bedridden patients if the cough reflex is suppressed by drugs.

Symptoms of hospital-acquired pneumonia in adults

Hospital-acquired pneumonia can be of two types:

  • early, if symptoms occur from 3 to 5 days from the moment of admission to the hospital – the pathogens are usually less aggressive, the symptoms are not very severe;
  • late, when signs of pneumonia are detected after a week or more – the course of such inflammation is very serious, the prognosis for life is poor.

The symptoms of nosocomial pneumonia are erased, so it is difficult to recognize the onset of inflammation in time. This is largely due to the general serious condition of the patient, the use of a large number of medications, age and other factors.

Key symptoms:

  • an increase in temperature or its return after a decrease;
  • increased sputum production, increased cough, change in color, odor or volume of sputum;
  • the appearance or increase of shortness of breath;
  • chest pain;
  • increased breathing and heart rate;
  • decreased pressure, pallor;
  • decrease in blood oxygen saturation less than 95%.

Treatment of hospital-acquired pneumonia in adults

Any changes in well-being when the patient is in the hospital should be immediately announced to the doctor. The doctor will prescribe additional procedures to exclude the development of complications.

Diagnostics

If pneumonia is suspected, the doctor will repeat the blood tests, comparing the results with previous ones. In addition, the following will be done:

  • chest x-ray or CT;
  • sputum culture;
  • biochemical research;
  • measurement of blood gases.

If SARS is suspected, the doctor will also conduct a PCR study to determine the specific cause of the inflammation.

Modern treatments

The main problem in the treatment of this disease is the resistance of hospital microbes to antibiotics, which are used to treat common pneumonia. Therefore, drugs are selected only after studying sputum culture data and determining the sensitivity of bacteria to the drug. Most often, funds from the reserve group are used – cephalosporins of 3-4 generations, protected penicillins, aminoglycosides, fluoroquinolones. Sometimes extremely rare medicines are needed. The doctor also recommends:

  • move as much as possible so that there is no stagnation of sputum in the lungs;
  • perform simple breathing exercises and a complex of exercise therapy;
  • drink more fluids (if this is not possible, put systems with saline and glucose);
  • use antipyretics for fever (Nurofen, Ibuklin, Paracetamol, Fervex, Rinza);
  • use drugs to thin and remove sputum (Fluimucil, ACC, Ambrobene, Bromhexine, Pertussin);
  • wear compression stockings to prevent thrombosis in the legs;
  • take vitamins.
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Prevention of hospital-acquired pneumonia in adults at home

Nosocomial pneumonia is dangerous, so it is important to carry out prevention from the first day of admission to the hospital. Doctors carefully monitor the patient’s condition after surgery, injury or during an exacerbation of the disease. But the patient himself needs to take part in prevention:

  • if possible, move more so that there are no congestion in the lungs;
  • follow all doctor’s recommendations;
  • carefully control your well-being;
  • avoid contact with sick relatives when visiting them;
  • engage in strengthening immunity;
  • take courses of recommended exercise therapy and physiotherapy.

Popular questions and answers

Nosocomial pneumonia is a serious problem of modern medicine. What are their features, why are they dangerous and what to do if you get sick, we asked pulmonologist Victoria Vavilova.

What are the features of nosocomial pneumonia?
Nosocomial (hospital-acquired) pneumonia is an acute infectious lung disease that develops 48 hours or more after hospitalization.

Its signs are “fresh” focal or infiltrative changes on the radiograph, as well as a number of symptoms confirming the infectious nature of the disease:

● new wave of fever;

● purulent sputum;

● changes in the blood test – an increase or decrease in the number of leukocytes;

● other symptoms.

It is important to exclude infections that at the time of the patient’s admission to the hospital could already be in his body in the incubation period.

One form of hospital-acquired pneumonia is ventilator-associated pneumonia. This is inflammation of the lungs, which develops no earlier than 48 hours after intubation and the start of mechanical ventilation. And provided that before that there were no signs of bronchopulmonary infection at the moment. This type of pneumonia is of particular importance during a real pandemic with increasing antibacterial resistance (insensitivity to antibiotics).

Most sick days are caused by a combination of microorganisms, most commonly Pseudomonas aeruginosa, E. coli, Klebsiella pneumonia, and Acinetobacter.

Many risk factors contribute to the development of the disease: advanced age (65 years or more), smoking, respiratory diseases, influenza, chronic diseases of the cardiovascular system, diabetes mellitus, renal failure, alcoholism, malnutrition, coma, injuries, burns, any focus infections in the body, poor oral hygiene.

What are the complications of hospital-acquired pneumonia?
Among the main complications of hospital-acquired pneumonia are lung abscess and pleural empyema (purulent lesions of the lung and its membrane).
When to call a doctor at home for hospital-acquired pneumonia?
This disease develops in hospitalized patients. However, one can imagine such a situation that the patient spent more than 2 days in the hospital, was discharged, and symptoms of pneumonia appear on the same or the next day. In this case, you should immediately call an ambulance. And it is important to tell the doctor about a recent hospital treatment.
Is it possible to treat hospital-acquired pneumonia with folk remedies?
Hospital-acquired pneumonia should be treated only in a hospital setting. The tactics of treatment is determined by the severity of the course of the disease. The key point of modern treatment is the immediate appointment of antibiotic therapy, the choice of drugs and schemes of which depend on the timing of the development and severity of pneumonia.

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