Aspiration Pneumonia and Aspiration Pneumonitis - Diagnosis and Management Summary
• 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)
• 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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