Pneumonia, Aspiration

[New Engl J Med 2019;380:651-63]

 

- Development of radiographically evident infiltrate following the aspiration of colonized oropharyngeal material.

Risk factors:

  • decreased level of consciousness
  • dysphagia
  • anatomic abnormality of upper GI tract
  • mechanical interference of GI tract (ET/NG tubes)

Clinical:

  • usually older patient with above risk factors
  • infiltrates in dependent lung segments, especially RLL
  • episode of aspiration often not witnessed
  • may progress to abscess/empyema within 1-2 weeks.

Etiology:

  • role of anaerobes is controversial and may have been overemphasized in the past
  • Gram stain may be helpful in diagnosis and decision to use antianaerobic therapy
  • choice of antibiotic dependent on clinical situation
  • ceftriaxone has activity against many oral anaerobes.

- For immunocompromised patients, recommend Infectious Diseases consult.