Aspiration Pneumonia and Aspiration Pneumonitis - Diagnosis ...

Aspiration Pneumonia and Aspiration Pneumonitis - Diagnosis and Management Summary

Aspiration Pneumonia:

 • Definition: Pneumonia caused by the excessive entry of secretions, particulate matter, or fluid into airways (NB: ALL pneumonias are secondary to micro-aspiration events; the term ‘aspiration pneumonia’ refers to macro-aspiration events)

 • Predisposing Factors: ↓ consciousness (seizure/overdose), esophageal dysmotility, post-bronchial obstruction, gum dz

 • Microbiology: Classically caused by polymicrobial infections including oral anaerobes (Peptostreptococcus, Fusobacterium, Bacteroides), but most common organisms are GNRs and standard CAP/HAP organisms.

 • Characteristics: Indolent, putrid sputum, pulmonary necrosis w/ cavitation/abscess/empyema

 • Workup: CXR, sputum culture (anaerobic respiratory culture not performed at MGH due to low utility)

 • Empiric Treatment: CAP treatment ± anaerobic coverage (see below)

 • Anaerobic Coverage: Per IDSA guidelines, anaerobic coverage only recommended in pts w/ loss of consciousness secondary to alcohol/drug overdose or seizure AND concomitant gingival disease or esophageal dysmotility.

    o First line: ampicillin-sulbactam (or amox/clavulanate if not severely ill); alternative: [CTX + metro] OR clindamycin

 • Duration: 7d (unless complicated by cavitation/abscess/empyema)

Aspiration Pneumonitis:

 • Definition: Aspiration of chemical substances into the airways without bacterial infection

 • Clinical Manifestations: Abrupt onset (2hr), low-grade fever, ↑ WBC, hypoxemia, CXR consolidation (RML/RLL upright, RUL supine) → may be indistinguishable from pneumonia in the acute setting!

 • Treatment: If concern for aspiration pneumonia (i.e., bacterial infection), may cover with abx for 48hrs  d/c if no consolidation develops on CXR OR if signs/sx/consolidation resolve rapidly (less likely to be PNA)

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