Aspiration Pneumonia
OVERVIEW
- Aspiration Pneumonia = aspiration of oropharyngeal contents which includes colonizing flora and leads to infection.
- Elderly have increased colonization with Staph aureus, aerobic gram-negative bacilli (Klebsiella and Escherichia coli) + dysphagia = pneumonia
- distinguishing from aspiration pneumonitis may be difficult, and the distinction is controversial.
CLINICAL FEATURES
- generally not witnessed
- typical symptoms
- infiltrate in bronchopulmonary segment
- those that aspirate in recumbent position -> posterior segments up upper lobes
- those that aspirate upright -> basal segments of lower lobes
- higher chance of cavitation and lung abscess formation
MANAGEMENT
- antibiotics:
-> benzylpenicillin + metronidazole
-> or clindamycin - – if aerobic gram –ve bacilli suspected (alcoholic patients)
-> metronidazole + ceftriaxone/cefotaxime/piperacillin-tazobactam/ticarcillin+clavulanate - – once defervesce -> amoxicillin-clavulanate or clindamycin
- 7 days of total therapy usually adequate
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC