What is hospital-acquired pneumonia
Hospital or nosocomial (another name is nosocomial) pneumonia is inflammation of the lungs that occurs during hospital treatment as a complication.
For pneumonia to be considered hospital-acquired, it must appear no earlier than 2 days after the patient was admitted to the clinic. In addition, the key characteristic of this type of pneumonia is the pathogens. Inflammation is caused by the so-called nosocomial, multi-resistant flora.
Hospital-acquired pneumonia is one of the three most common complications of hospital treatment; most often, only wound suppuration and inflammation of the urinary tract occur.
Diagnosis of obstructive pulmonary inflammation
Obstructive pneumonia can be successfully treated if diagnosed in a timely manner; various studies are carried out for this purpose. When collecting anamnesis, a pulmonologist identifies the patient’s bad habits, as well as the impact of occupational factors.
One of the main diagnostic methods is radiography, which allows one to determine damage to the lung tissue and organ deformities. In addition, to assess the condition of the respiratory system, the patient may be prescribed spirometry, in which the doctor receives data on breathing volume, reserve volume during exhalation and inhalation, vital capacity and other indicators.
To determine the nature of the disease, a sputum examination is performed, which also allows one to exclude cancer. Clinical blood tests for obstructive pneumonia show an increase in the number of leukocytes, blood viscosity and an increase in hemoglobin and hematocrit.
In the therapy clinic of the Yusupov Hospital, you can undergo the necessary examination, as well as begin treatment for the disease with experienced pulmonologists who regularly improve their knowledge and skills. The Yusupov Hospital is equipped with modern equipment that allows obtaining high-precision diagnostic data, on the basis of which a diagnosis is made.
Causes of hospital-acquired pneumonia in adults
The main provocateurs of hospital-acquired pneumonia are gram-negative bacteria living within the walls of hospitals.
These are Klebsiella, Pseudomonas aeruginosa, Proteus, Serracia or Escherichia coli. They account for up to 30% of all pneumonias. Almost a third of pneumonia of this type is caused by aggressive nosocomial types of Staphylococcus aureus. Another 30% of lung inflammation is caused by fusobacteria and bacteroides (anaerobe bacteria). About 4% of all hospital-acquired pneumonias are caused by Legionella - these bacteria can cause outbreaks if they multiply in the ventilation system and spread throughout the hospital.
Much less frequently, in approximately 1% of cases, hospital-acquired viral pneumonia occurs. The most common causative agents are influenza viruses, RS virus and, in some cases, cytomegalovirus.
Key risk factors for developing hospital-acquired pneumonia:
- long hospital stay;
- bed rest, when the patient practically cannot move;
- too frequent and prolonged use of antibiotics without strict indications;
- elderly age;
- the patient's serious condition associated with circulatory disorders, extensive surgical interventions, blood loss or injury, shock;
- severely suppressed immunity.
In addition, the risk of developing pneumonia increases after certain medical procedures - bronchoscopy and breathing through a tracheostomy, being on mechanical ventilation (every day the risk increases by 1%), frequent vomiting in bedridden patients if the cough reflex is suppressed by drugs.
COVID-19 and more: what are the features of viral pneumonia?
This disease is popularly called pneumonia, and in medical circles - pneumonia. Now, during a pandemic, the risk of contracting pneumonia increases - this is one of the complications of coronavirus infection.
How common are viral pneumonias? What viruses can cause them? What is the value of CT scan of the lungs in viral pneumonia? We are talking about this and much more with Igor Ivanovich Anufriev, Candidate of Medical Sciences, pulmonologist at the Expert Clinic in Rostov-on-Don.
— Igor Ivanovich, let’s start with a definition: what is pneumonia and why is attention focused on it now?
— Pneumonia is an inflammatory disease of the lungs. Pneumonia usually attracts attention twice a year, during times of increased risk of respiratory diseases: in spring and autumn. Now it is the most common complication of COVID infection (coronavirus infection).
— The lungs, like, perhaps, most other organs, can be affected by completely different infectious pathogens. These include bacteria, viruses, and fungi. During this period of time, the coronavirus infection COVID-19 has probably significantly skewed the statistics of viral pneumonia. Generally speaking, how common is viral pneumonia?
— They occur quite often, but less frequently than bacterial ones. Viruses often become a trigger for the onset of the disease, and subsequently pneumonia can become viral-bacterial. In this case, inactivation of the virus and antibiotic therapy will be needed.
Read material on the topic: Viruses and bacteria - what is the fundamental difference?
— Please tell us in more detail what viruses can cause pneumonia?
— Pneumonia is caused by influenza viruses, parainfluenza, and respiratory syncytial virus. This is the first group of pathogens.
Adenoviruses and COVID viruses that appeared earlier can also lead to pneumonia: SARS virus (2002 severe acute respiratory syndrome in Southeast Asia) and MERS-CoV (2015 Middle East respiratory syndrome). COVID-19 is now widespread.
— Doctors say that with COVID-19 there may be a mild course of the disease. Why is this possible?
— This is influenced by several factors.
The first is the non-virulence of the virus in a particular patient, when the infectious agent is less capable of causing the disease.
The second is the state of immunity of the population and specific individuals who become infected. Thanks to their strong immunity, they may not get pneumonia.
80% of patients who are infected with COVID-19 have mild symptoms, in some cases indicating an inflammatory process in the lungs. The patient sometimes does not pay attention to them, but the doctor will notice. In children, viral pneumonia can occur without symptoms.
Only 20% of those infected experience severe pneumonia.
INTERESTING FACTS: IF YOU ARE INFECTED WITH COVID-19, YOUR SENSE OF OLMMOR POSSIBLE. INFORMATION HAS BEEN RECEIVED THAT SUCH PATIENTS HAVE SKIN RASHES, ESPECIALLY ON THE LOWER EXTREMITIES (CHILDREN AND UPPER EXTREMITIES) - THIS IS A NEW ASPECT, STILL DIFFICULT TO EXPLAIN FOR SCIENTISTS
— What are the signs of viral pneumonia? Are there any peculiarities depending on the virus that caused the disease - for example, with COVID-19?
— Among the clinical manifestations of pneumonia, in particular with COVID-19, one can distinguish fever, increasing shortness of breath, severe weakness, severe intoxication syndrome, and oxygen deprivation. Symptoms of respiratory failure and pulmonary edema predominate - in this case intensive resuscitation measures are necessary.
Pneumonia can also be caused by other viral agents, including, for example, influenza viruses, adenovinus, and respiratory syncytial infections. Thus, with influenza complicated by pneumonia, symptoms similar to COVID appear: acute respiratory failure, severe shortness of breath, low oxygen levels in the blood. However, they are not so difficult and intense.
— Someone said that a diagnosis is a guide to action. How can doctors detect viral pneumonia? How can they confirm that it is viral?
— If the doctor finds out that the patient has some of the symptoms that we talked about, then he may recommend doing a computed tomography (CT) scan of the lungs. It helps detect the inflammatory process in the lung tissue. A referral for a CT scan is required under the compulsory medical insurance program if the doctor considers this study necessary for the patient. You can undergo a CT scan for a fee if you wish, without a referral, but it is worth consulting with a specialist.
How is it determined whether pneumonia is caused by a virus? I’ll tell you using the example of COVID. Now in different countries, including Russia, they are creating tests to detect this virus in the body. The test is an analysis of cells from the oropharynx or nasopharynx for the presence of ribonucleic acid (RNA) of the virus. It is carried out using the PCR method - polymerase chain reaction.
Read more about the PCR method in our article: Diagnosis of infections using PCR: what is it?
Recently, mucus can also be used for analysis when performing bronchoscopy, and blood. The result comes quite quickly, depending on the type of test (the time to receive an answer ranges from several hours to three days).
Tests are carried out only in medical institutions. The patient can donate them in two ways:
1. After the doctor's appointment. They are done free of charge at Rospotrebnadzor institutions. 2. At your own request. They need to be done for a fee.
— You said that a CT scan is done to detect inflammation in the lungs. But there are other x-ray diagnostic methods. For example, does fluorography or radiography show viral pneumonia?
— Compared to computed tomography, radiography shows only 50% of cases of pneumonia, and fluorography is even less effective. It is recommended to perform a CT scan first.
— Igor Ivanovich, please tell us about the principles of treatment of viral pneumonia
— If we are talking about viral pneumonia with COVID-19, the doctor may prescribe some drugs used in the treatment of malaria, HIV infection, as well as interferon alpha and beta preparations. Antiviral agents are also used to slow down the penetration of viruses into lung cells.
As I already said, there are not so many cases of viral pneumonia: they are often accompanied by a bacterial infection. For viral-bacterial pneumonia caused by COVID-19, antibiotics are also used that are clearly defined for different types of microorganisms.
Pneumonia can also be a complication of other viral diseases, such as influenza. When treating it, the Ministry of Health recommends starting antiviral therapy. If there is a suspicion of the development of bacterial-viral pneumonia, then, as in the case of COVID, antibiotics are prescribed. Antipyretics and some other drugs are also used.
— How long does it take to treat viral pneumonia?
— The duration of treatment is individual. One case when the patient has an asymptomatic or low-symptomatic course of the disease. Treatment will be completely different if the course is moderate, severe or very severe. Therefore, the duration depends on what type of pneumonia prevails and what clinical picture is observed in the patient.
In the best case, treatment lasts about three weeks.
— Are there any folk remedies for viral pneumonia? And how do doctors look at such treatments?
- This is from the category “It would be funny if it weren’t so sad.” Doctors have a negative attitude towards such methods. Folk remedies do not replace antiviral treatment. None of the traditional medicine drugs act on the virus, although to some extent they can affect the immune system, improving the body's resistance. But this also depends on the specific means.
“And, of course, the issue of prevention cannot be ignored. How to prevent the development of viral pneumonia?
— A viral infection often comes more than once. Along with COVID-19, the influenza virus can also be detected, so first of all, it is worth getting vaccinated against it - once a year in the second half of September, so that immunity can develop over the next 3-4 weeks.
Vaccinations: where is the truth and where is the lie? Read an interview with a doctor from the Clinic Expert network
The second is to lead a healthy lifestyle, give the body physical activity, since physical activity helps improve immunity.
Third, visit places with large crowds of people as little as possible: shops, clinics, banks.
Fourth, avoid close contact with people. Do not meet with potential sick people, do not greet with a handshake. Why do some countries have a very high percentage of cases? Residents of these countries are temperamental (hug, kiss) and not entirely disciplined, although the government and health authorities urge them to be careful.
With a more responsible approach, the outbreak of pneumonia due to COVID-19 can be quickly extinguished. Therefore, for now, it is better for Russians to follow the rules of disinfection, wash their hands thoroughly and stay at least 1.5-2 m away from each other. This is necessary not only for doctors, but also, first of all, for you.
Interviewed by Yulia Kovalenko
You can make an appointment with a pulmonologist here You can sign up for a CT scan of the lungs here ATTENTION: services are not available in all cities
The editors recommend:
Lung CT: what are the capabilities of this diagnostic method? What is ARVI? Immunity is not on the side of Rosa Luxemburg and Clara Zetkin. Why doesn't nature recognize equality? Are unvaccinated children the healthiest?
For reference:
Anufriev Igor Ivanovich
1972 - graduate of Rostov State Medical University with a degree in General Medicine, 1973-1975. — works as a doctor in the cardiology department of Emergency Hospital No. 2 in Rostov-on-Don. In 1981 he defended his dissertation on myocardial infarction. In 1982 he received primary specialization in acupuncture, and in 1984 - specialization in pulmonology at the St. Petersburg Institute of Pulmonology Currently, Igor Ivanovich is a candidate of medical sciences, a pulmonologist of the highest category, a full member of the European Respiratory Society (Switzerland, Lausanne)
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 hospital-acquired pneumonia are subtle, so it is difficult to recognize the onset of inflammation on 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, worsening cough, change in color, odor, or volume of sputum;
- the appearance or worsening of shortness of breath;
- chest pain;
- increased breathing and heart rate;
- decreased blood pressure, pallor;
- decrease in blood oxygen saturation less than 95%.
How?
Irritation appears in places where toxic substances are deposited. Large grains (from 10 to 20 microns, or one to two hundredths of a millimeter) settle in the upper respiratory tract, smaller particles (from 5 to 10 microns) - in the trachea and bronchi, and “guests” less than 5 microns can reach the alveoli. After a foreign “guest” enters, damage (alteration) of epithelial cells occurs, which “helps” the development of bronchospasm. Then swelling of the bronchial mucosa with accumulation of exudate (purulent fluid) in the alveoli and so on until the epithelium is destroyed!
The amount of damage caused by damaging substances depends on the physical properties, concentration, exposure time, temperature and humidity, and the presence of pathogenic microbes.
Modern methods of treatment
The main problem in the treatment of this disease is the resistance of hospital microbes to antibiotics used to treat common pneumonia.
Therefore, medications are selected only after studying sputum culture data and determining the sensitivity of bacteria to the drug. Most often, drugs from the reserve group are used - cephalosporins of 3-4 generations, protected penicillins, aminoglycosides, fluoroquinolones. Sometimes extremely rare drugs are needed. The doctor also recommends:
- move as much as possible so that there is no stagnation of phlegm in the lungs;
- perform simple breathing exercises and exercise therapy;
- drink more fluids (if this is not possible, systems with saline and glucose are installed);
- use antipyretics for fever (Nurofen, Ibuklin, Paracetamol, Fervex, Rinza);
- use medications to thin and remove mucus (Fluimucil, ACC, Ambrobene, Bromhexine, Pertussin);
- wear compression stockings to prevent thrombosis in the legs;
- take vitamins.
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 to avoid congestion in the lungs;
- follow all doctor's recommendations;
- carefully monitor your well-being;
- avoid contact with sick relatives when visiting them;
- strengthen the immune system;
- take courses of recommended exercise therapy and physiotherapy.
