Hospital and Institutional Acquired Pneumonia – Causes, Risk Factors, Symptoms, Treatment, Complications

Hospitals are the places for curing the diseases of the patients; however patients may also get certain disease from hospitals. A Hospital-acquired pneumonia is one such infection that gets transmitted to the hospitalized patients after about 2 days or more of hospitalization.

In case of Institution-acquired pneumonia, people in close contact with the nursing homes or hospital facilities; get infected with pneumonia.

A Hospital-acquired pneumonia is more severe than Institution-acquired pneumonia because the infectious agents in the former are harder to treat. Another reason is that hospitalised patients have are already sick and have weakened immune system.

Moreover, the types of infectious agents present in a hospital are more lethal than those present in the community.

Causes of HAP/IAP

HAP/IAP is caused by wide variety of infectious agents including Bacteria, Viruses, Fungi, parasites, etc. The infection may vary from mild to life-threatening.

Common Bacteria: Streptococcus pneumonia, anaerobic organisms, Mycobacterium tuberculosis.

Common Viruses: Rhinoviruses, Coronaviruses, Influenza virus, Respiratory syncytial virus (RSV), Adenovirus

Common parasites: Toxoplasma gondii, Strongyloides stercoralis

Common Fungi: Histoplasma capsulatum, blastomyces, Cryptococcus Neoformans

Risk Factors of HAP/IAP

Risk factors for HAP/IAP comprises of the following.

                    Individuals working on ventilator   

                    Alcoholism

                    Being on a breathing machine

                    Breathing saliva

                    Taking food into the lungs (aspiration)

                    Chest surgery

                    Immuno-suppression    

                    Long-term (chronic) lung disease

                    Not being fully alert

                    Older age

                    Recent illness

Symptoms of HAP/IAP

Common Symptoms

                    Cold and Cough

                    Fever

                    Shaking chills

                    Difficulty in breathing

                    Severe Chest Pain

                    Clammy skin due to excessive sweating

                    Weakness and fatigue

                    State of Confusion in elderly people

                    Loss of appetite

                    Headache

Diagnostic Tests

HAP/IAP can be diagnosed by conducting the following tests.

                    Physical examination to detect the presence of crackles, decreased oxygen and respiratory distress

                    Chest x-ray or CT scan

                    Arterial blood gases

                    Complete blood count (CBC)

                    Sputum culture

                    Sputum gram stain

                    Blood cultures

Treatment for HAP/IAP

The treatment of HAP/IAP depends on the infectious agent responsible for the infection. Depending on the severity of the infection, the treatment can be done at home or hospital.

                    Bacteria (gram negative, s.pneumoniae) are treated with intravenous antibiotics after they are identified using sputum culture.

                    Atypical Bacteria are treated with different set of antibiotics

                    Viral Pneumonia is treated with set of anti-virals

                    Severely ill patients are placed in intensive care unit and put on a ventilator

                    Supplemental oxygen for loosening and expelling thick mucus from the lungs

                    Intravenous fluids for preventing dehydration is given patients in hospitals

                    Use of humidified air helps in loosening the mucus

                    Patient may take aspirin, NSAIDs, for controlling fever. However, Aspirin should not be given to children.

                    Patient is advised to take plenty of rest.

                    Chest therapy is used for loosening the mucus so that it can be expelled out by deep coughing.

Complications

The complications of the HAP/IAP pneumonia may lead to serious health conditions.

                    Acute respiratory distress syndrome (ARDS)

                    Lung abscess

                    Bacteraemia

                    Septicaemia

                    Low blood pressure