Pneumonia symptoms

Nosocomial pneumonia: symptoms, diagnosis and treatment

Nosocomial pneumonia (NHP), also known as nosocomial pneumonia, is a bacterial infection of the lower respiratory tract that occurs 48 hours or more after admission to hospital and does not appear due to intubation at the time of admission.

People experience a host of symptoms ranging from fever and chills to shortness of breath and chest pain and are at higher risk of developing serious complications and even death. Infections are also much more likely in older people and those who are unhealthy or immunocompromised.

This article discusses the symptoms, causes, diagnosis, and treatment of nosocomial pneumonia.

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The first sign of nosocomial pneumonia may be a change in mental status, irritability, or confusion, but cases vary greatly from person to person. Other common symptoms include:

  • Productive cough (cough accompanied by greenish or pus-like mucus called sputum)
  • Fever
  • Chills
  • General discomfort, malaise or feeling sick (malaise)
  • Loss of appetite
  • Nausea and vomiting
  • Sharp chest pain that gets worse with deep breathing or coughing
  • Shortness of breath

Common causes

PAH is caused by bacteria, in particular aerobic bacilli (capable of growing in an air atmosphere) that are Gram-negative, such as:

The following risk factors may put you at higher risk of contracting PAH:

  • Alcohol abuse
  • History of thoracic surgery or other major surgery
  • Immune system weakened by cancer treatment, certain medications, or severe injury
  • Chronic lung disease
  • Advanced age
  • Are not mentally alert due to medication or illness
  • Are on a respirator


PAH is indistinguishable from other forms of pneumonia, so a diagnosis is usually made based on:

  • A person’s symptoms: People with PAH often present with a cough, chest pain on deep breathing, shortness of breath, and sputum production.
  • The presence of consolidation or opacities in the lungs: This is found via a chest X-ray or CT scan.

One or more of the following factors also help diagnose PAH:

Bacterial culture is considered the gold standard for confirmation of pneumonia. Cultures can be obtained from:

  • Sputum
  • Nasotracheal suctioning (using the nasal cavity as a pathway for inserting a suction catheter into the trachea through the larynx)
  • Bronchoscopy
  • Blood cultures

A lower respiratory tract culture should be obtained before starting antibiotics; Not only is this helpful in diagnosing the exact cause of your PAH, but it also allows your healthcare provider to de-escalate antibiotics and focus on eliminating the offending pathogen.


If nosocomial pneumonia is suspected, your antibiotic treatment will likely be chosen based on your local susceptibility patterns, i.e. the likelihood of the bacterium in question being killed by a given antibiotic based on its responsiveness to treatment and your risk. to develop resistance to antibiotics.

Antibiotic-resistant organisms – bacteria that have learned to avoid the killing mechanisms of antibiotics – are of growing concern.

Antibiotics can be given orally or intravenously depending on your severity. Antibiotics given in the hospital are more likely to be given through an intravenous line placed in your arm. If you need outpatient antibiotics, you will likely receive a prescription for an oral tablet that you can take by mouth.

If the risk of bacterial resistance is low in the hospital, the following antibiotics may be used to treat PAH:

  • Zosyn (piperacillin/tazobactam)
  • Maxime (cefepime)
  • Levaquin (levofloxacin)
  • Primaxin IV (imipenem/cilastatin)
  • Merrem (meropenem)

If the risk of bacterial resistance is high, vancomycin or linezolid should be added to the treatment regimen. Sometimes it may be necessary to use “high guns” to defeat pseudomonas infections that are resistant to this regimen. Adding any of the following can be effective:

  • An antipseudomonal cephalosporin (cefepime or ceftazidime)
  • An antipseudomonas carbapenem (imipenem, meropenem)
  • A beta-lactam/beta-lactamase inhibitor (piperacillin/tazobactam)
  • An antipseudomonal fluoroquinolone (ciprofloxacin or levofloxacin)
  • An aminoglycoside (amikacin, gentamicin, tobramycin)


Studies consistently show that people with PAH are at an increased risk of all-cause mortality, sometimes up to 50%, despite the availability of effective antibiotics.

Even when people survive the primary infections that cause PAH, they are at risk of dying from associated pre-existing health conditions that may have worsened during their recovery from infection.

Variables associated with increased mortality include:


Nosocomial pneumonia (NAP), also known as nosocomial pneumonia, is a bacterial infection of the lower respiratory tract that occurs 48 hours or more after admission to hospital.

It is most often caused by gram-negative bacilli and can occur in anyone, although immunocompromised people are most at risk.

A word from Verywell

PAH is often a serious medical complication that healthcare providers take serious precautions to prevent. Still, it can be difficult to determine early signs of PAH, especially when the affected person is already ill, which underscores the importance of closely monitoring any small changes that may occur in a loved one’s condition.

If you suspect a friend or family member has PAH, notify a healthcare provider immediately, as early initiation of broad-spectrum antibiotics has been shown to decrease the likelihood of morbidity and mortality.