Hospital-acquired pneumonia (non COVID-19)

Last reviewed: 30 May 2022
Last updated: 25 Jan 2022

Summary

Definition

History and exam

Key diagnostic factors

  • cough with increasing sputum production
  • dyspnoea
  • fever
  • presence of risk factors
Full details

Other diagnostic factors

  • chest pain
  • asymmetrical expansion of the chest
  • diminished resonance
  • abnormal auscultatory findings
  • tachycardia
  • malaise/anorexia
Full details

Risk factors

  • poor infection control/hand hygiene
  • intubation and mechanical ventilation
  • multidrug-resistant bacteria
  • aspiration
  • acid-suppression drugs
  • depressed consciousness
  • chest or upper abdominal surgery
Full details

Diagnostic investigations

1st investigations to order

  • oxygen saturations
  • chest x-ray
  • full blood count
  • blood gas
  • C-reactive protein
  • renal and liver function tests (LFTs)
  • culture of sputum, nasopharyngeal swab, or tracheal aspirate samples
Full details

Investigations to consider

  • CT scan chest
  • chest ultrasound
  • thoracocentesis and pleural fluid culture
  • urine antigen testing
  • PCR and/or serological tests including for SARS-CoV-2
Full details

Treatment algorithm

ACUTE

severe symptoms/signs or at higher risk of resistance

mild to moderate symptoms/signs and not at higher risk of resistance

Contributors

Expert advisers

Jonathan Bennett, MD

Honorary Professor of Respiratory Sciences

University of Leicester

Respiratory Consultant

Glenfield Hospital

Leicester

UK

Biography

JB is Chair of the British Thoracic Society.

Disclosures

JB declares that he has no competing interests.

Claire Vella, MD, MRCP

Clinical Fellow Lung Cancer and Interventional Pulmonology

Glenfield Hospital

University Hospitals of Leicester NHS Trust

Leicester

UK

Disclosures

CV declares that she has no competing interests.

Acknowledgements,

BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:

Forest W. Arnold, DO MSc, FIDSA

Associate Professor of Medicine

Division of Infectious Diseases

Department of Medicine

School of Medicine

University of Louisville

Louisville

KY

Disclosures

FWA declares that he has no competing interests.

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Disclosures

Peer reviewers

Jeremy Brown, MBBS, MRCP, PhD

Professor of Respiratory Infection/Honorary Consultant

University College London

London

UK

Disclosures

JB was a member of the NICE pneumonia guidelines committee.

Editors

Helena Delgado-Cohen,

Section Editor, BMJ Best Practice

Disclosures

HDC declares that she has no competing interests.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

Disclosures

RW declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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