Aspiration pneumonia bacterial infection
| Aspiration pneumonia bacterial infection | ||
| ICD-10 | J12, J13, J14, J15, J16, J17, J18, P23 | |
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| ICD-9 | 480-486, 770.0 | |
| DiseasesDB | 10166 | |
| MeSH | pneumonia bacterial infection&field=entry#TreeC08.381.677 C08.381.677 | |
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Aspiration pneumonia bacterial infection Microchapters |
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Differentiating Aspiration pneumonia bacterial infection from other Diseases |
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Diagnosis |
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Treatment |
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Aspiration pneumonia bacterial infection On the Web |
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American Roentgen Ray Society Images of Aspiration pneumonia bacterial infection |
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Directions to Hospitals Treating Aspiration pneumonia bacterial infection |
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Risk calculators and risk factors for Aspiration pneumonia bacterial infection |
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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Associate Editor(s)-In-Chief: Priyamvada Singh, M.D. [2]
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Aspiration pneumonia bacterial infection from other Diseases
Epidemiology and Demographics
Risk factors
Natural History, Complications and Prognosis
Prognosis predictor scores: CURB-65 | Aspiration pneumonia bacterial infection severity index | Criteria for severe community acquired Aspiration pneumonia bacterial infection
Diagnosis
Diagnostic criteria | History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray
Treatment
Diagnosis
History and symptoms
The manifestation depends on:
- The bacteria involved
- Time since aspiration to diagnosis
- Immune status of the host
Symptoms in aerobic microbes
- Abrupt or Indolent course
- Productive cough
- Fever
- Absence of chills and rigors
- Dyspnea
- Anorexia, weight loss
- Anemia
Lab diagnosis
Sputum culture
- Expectorated sputum is not used as an diagnostic tools as contamination by the normal flora of the mouth and airways is inevitable.
- Specimen obtained via bronchoscopy may be suitable but limited studies are available to prove this.
Symptoms in anaerobic microbes
Clinical features, which are characteristic of aspiration pneumonia involving anaerobic bacteria, include:
- Indolent course
- Presence of risk factors: altered sensorium (anesthesia, alcohol, drug, trauma, dysphagia, dental caries)
- Putrid sputum
- Absence of chills and rigors
Chest X Ray
- Lung abscess
- Empyema
- Involvement of dependent pulmonary lobes i.e., upright position lower lobe, superior segment of lower lobes or posterior segment of upper lobes in recumbent position
Natural History, Complications and Prognosis
- Lung abscess
- Necrotizing pneumonia
- Empyema
- Bronchopleural fistula
Risk factors
- Poor dental hygiene is a risk factor
- Patients with good dental hygiene and edentulous are less predisposed
Treatment
Medical therapy
Antibiotics
- Treatment of choice clindamycin
- Doses 600 mg Q8hourly, followed by 300 mg Q6hourly, or 450 mg tid
- Advantage of clindamycin :
- Cheap
- Less incidences of superimposed MRSA
- Other agents used: Ampicillin-sulbactam (1.5 g or 3 g twice daily), Imipenem (Invanz 500 mg BID), amoxicillin-clavulnate (875 mg orally bid), penicillin (1 to 2 million units IV Q6hourly) / amoxicillin (500 mg orally tid)+ metronidazole (500 mg orally or IV tid).
- Monotherapy with metronidazole is not preferred as high failure rates have been reported. This is because metronidazole is ineffective against some pathogens such as microaerophilic and aerobic streptococci