About 18 percent of patients who acquired pneumonia in a hospital died as a result of the infection, compared with less than 7 percent of those infected outside of hospitals, according to a study in the Annals of Internal Medicine.

About a quarter of the patients studied contracted pneumonia through a non-hospital health-care setting, almost double the amount of patients who were sickened in the hospital, and comes amid a rise in treatment at nursing homes, pain clinics, and dialysis centers, wrote study author Mario Vendetti of the department of clinical medicine at the University of Rome.

Doctors should be aware that resistant infections may arise at such centers, said Alan Taege, an infectious disease specialist at the Cleveland Clinic.

“In the past we hadn’t thought so much about pain centers and dialysis centers, but what you’re doing is clustering ill people together,” Taege, who wasn’t involved in the study, said in an interview today. “In past years we didn’t think so much about these settings as being ones in which patients may acquire an atypical pathogen.”

Many of the deaths in the hospital-acquired and health-care- acquired groups were attributed to using an antibiotic that wasn’t powerful enough to kill the germs, Taege said.

Making the Rounds

The study covered 362 patients in Italy and suggests new patients should be surveyed about any health-care centers they attend. Doctors should use different antibiotics for patients whose diseases aren’t acquired in the community, the study said.

Pneumonia, a lung infection that can be caused by bacteria, viruses or fungi, kills about 60,000 Americans a year, according to the Mayo Clinic Web site. People who require machines to help them breathe are particularly at risk because such devices bypass the lungs’ usual defenses and can harbor bacteria.

Another study in the same journal looked at outbreaks of hepatitis B and C, and found that facilities like dialysis clinics didn’t follow the basic elements of infection control, according to a report from the Centers from Disease Control and Prevention. As more people use non-hospital health care, staff of such clinics should be trained in infection control to make sure patients are protected.

Many of the hepatitis outbreaks were due to unsafe injections, according to the CDC study. Such cases are probably underreported and “probably represent a much wider problem,” according to the CDC report.

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