Hospital-acquired pneumonia (HAP), also known as nosocomial pneumonia, is defined by the American Thoracic Society guidelines as pneumonias that occur more than 48 hours after hospital administration but were not present at the time of admission.
It may be a common cause of pneumonia in patients admitted to intensive care units (ICU) and those on mechanical ventilation. Indeed it is thought that ventilator-associated pneumonia is the commonest type of hospital acquired pneumonia 5. While all ages and both sexes can be affected, elderly patients are more prone to develop it.
Hospital acquired pneumonia is divided into:
- early onset: within 4 days of admission
- late onset: after day 5 of admission
Hospital acquired pneumonia commonly results from colonized upper respiratory tract infections being aspirated into the lower respiratory tract and ascending infection from the stomach (i.e. ingested oropharyngeal secretions).
Common organisms for early onset type are Streptococcus pneumoniae and Haemophilus influenzae.
Intubation and ventilatory support bypass normal defense mechanism predisposing patients to infection.
It is a clinical diagnosis with the imaging features of pneumonia, with no specific findings.
Areas of unilateral or bilateral consolidation may be seen depending on severity.
Treatment and prognosis
The early onset type has a better prognosis. High morbidity and mortality are seen in patients with hospital-acquired pneumonias as they are already hospitalized for another condition.
- 1. Herold CJ, Sailer JG. Community-acquired and nosocomial pneumonia. Eur Radiol. 2004;14 Suppl 3 (3): E2-20. doi:10.1007/s00330-003-2162-7 - Pubmed citation
- 2. Kollef MH, Shorr A, Tabak YP et-al. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest. 2005;128 (6): 3854-62. doi:10.1378/chest.128.6.3854 - Pubmed citation
- 3. Shindo Y, Sato S, Maruyama E et-al. Health-care-associated pneumonia among hospitalized patients in a Japanese community hospital. Chest. 2009;135 (3): 633-40. doi:10.1378/chest.08-1357 - Pubmed citation
- 4. Franquet T. Imaging of pneumonia: trends and algorithms. Eur. Respir. J. 2001;18 (1): 196-208. Eur. Respir. J. (full text) - Pubmed citation
- 5. Koenig SM, Truwit JD. Ventilator-associated pneumonia: diagnosis, treatment, and prevention. (2006) Clinical microbiology reviews. 19 (4): 637-57. doi:10.1128/CMR.00051-05 - Pubmed