Aspiration pneumonia refers to the pulmonary consequences of the abnormal entry of fluid, particulate exogenous substances, or endogenous secretions into the. The usual site for an aspiration pneumonia is the apical and posterior segments of the lower lobe of the right lung. However, in a critically ill patient with this syndrome, therapy should usually begin with penicillin 2 million u iv every 4. The chance of recovering from aspiration pneumonia depends on the original cause, how well you were before you developed it and whether you had any complications. The purpose of this document is to guide the appropriate treatment of adult patients presenting with pneumonia.
Aspiration pneumonia is a type of pneumonia caused by the accidental infiltration of food or other substances from the mouth or stomach into the lungs. If the patient is supine then the aspirated material may also enter the posterior segment of the upper lobes. Pdf aspiration pneumonia pathophysiological aspects. Chronic inflammation of the lungs is a key feature in aspiration pneumonia in elderly nursing home residents and presents as a sporadic fever one day per week for several months. Chest physiotherapy for pneumonia in adults cochrane. Antibacterial treatment of aspiration pneumonia in older people. The pathogens that commonly produce pneumonia, such as streptococcus pneumoniae, haemophilus influenzae, gramnegative bacilli, and staphylococcus aureus, are relatively virulent bacteria so that only a small inoculum is required, and the aspiration is usually subtle. The lungs reaction to these foreign microbes is to cause an inflammatory response causing the bronchioles and alveoli to fill with fluid and become solid1. This is a condition where pneumonia develops after youve inhaled bacteria through food, drink, saliva, or vomit into your lungs. In dogs and less frequently in cats, aspiration pneumonia is generally associated with inhalation of oral ingesta, regurgitated material, or vomitus. This type of pneumonia may be considered as mechanical one. Pneumonia that develops 48 hours or more after hospital admission and that was not incubating at hospital admission. Aspiration pneumonia do not treat aspiration suspected aspiration without evidence of pneumonia routine antibiotic treatment not indicated apart from patients with small bowel obstruction who will aspirate colonised gastric contents. Communityacquired aspiration pneumonia is usually treated with amoxicillinclavulanate.
Waiting for the results of culture is unwise and will disappoint because of the low yield. Disclosure forms provided by the authors are available with the full text of this article at. As a result, the true rate of aspiration pneumonia is difficult to quantify, and there is no definition that separates patients with aspiration pneumonia from all others diagnosed with pneumonia. Aspiration pneumonia aftercare instructions what you. Healthcareassociated pneumonia hcap is a new concept of pneumonia proposed by the american thoracic societyinfectious diseases society of america in 2005.
Ws risk factors, including recumbent position, gerd, and vomiting, as well as the abrupt onset of symptoms with prominent dyspnea, the nurse suspects aspiration pneumonia. It also depends on how quickly the condition was recognised and how soon effective treatment was started. Antibiotics represent the mainstay of pneumonia treatment, while other therapies are mostly supportive. Clindamycin 10mgkgdose ivpo q8h max 600mgdose po, 900mgdose iv consider possibility of aspiration pneumonitis rather than pneumonia if respiratory distress immediately follows aspiration event and resolves within 24h click here for guidance on. Aspiration pneumonia occurs when food, saliva, liquids, or vomit is breathed into the lungs or airways leading to the lungs, instead of being swallowed into the esophagus and stomach. Pneumonia is a serious infection occurring in hospitalized patients and is usually the second most common nosocomial infection after urinary tract infections. Aspiration aspirayshun pneumonia noomohnyah happens when a liquid or an object is inhaled into the lungs. Prevention of aspiration and the development of pneumonia. Aspiration pneumonia is a common diagnosis among patients seen in and out of the hospital. Persistent aspiration pneumonia is often due to anaerobes and it may progress to lung abscess or even bronchiectasis.
Pneumonia due to food, liquid or gastric contents aspirated into the upper respiratory tract. Healthcareassociated pneumonia and aspiration pneumonia. The causative agents in aspiration pneumonia have shifted from anaerobic to aerobic bacteria. Aspiration pneumonia the causative agents in aspiration pneumonia have shifted from anaerobic to aerobic bacteria. When managed in hospital the diagnosis is usually confirmed by chest xray. It appears as a result of the entry of liquid or solid particles into the lungs or lower airway tracts. Pulmonary aspiration is when you inhale food, stomach acid, or saliva into your lungs. Is penicillin g an adequate initial treatment for aspiration pneumonia. You may become less active as you age, or you may be bedridden. Cervids affected with chronic wasting disease may develop aspiration pneumonia due to cns dysfunction. Pneumonia is a severe form of an acute lower respiratory infection that specifically affects the lungs and is typically caused by bacteria, viruses or fungi. Aspiration pneumonia and pneumonitis australian prescriber.
Diagnosis and treatment of adults with communityacquired. Bacterial pneumonia treatment best antibiotic for pneumonia. This is unlikely to happen if youre a young, fit adult. The following also increase your risk for aspiration pneumonia. Treat staphylococcus aureus for a minimum duration of 7 days patients with empyema, infected pleural effusions, and bacteremia secondary to pneumonia may require longer durations of therapy. Hemodynamically unstable patients with aspiration events. Consider possibility of aspiration pneumonitis rather than pneumonia if respiratory distress immediately follows aspiration event and resolves within 24h click here for guidance on amoxicillinclavulanate maximum dosing and formulations.
Aspiration pneumonia pathophysiological aspects, prevention and management. Challenges remain in distinguishing aspiration pneumonia from chemical pneumonitis. Aspiration pneumonia symptoms and treatment patient. Aspiration pneumonia is an infection that may occur if a person breathes something in instead of swallowing it. Unless a healthcare professional tells you otherwise, you should always finish taking a prescribed course of antibiotics, even if you feel better. Aspiration pneumonia is a complication of pulmonary aspiration. Aspiration pneumonia is caused by saliva, food or stomach acid leaking into the lungs. Aspiration pneumonia in cattle after treatment for milk fever is usually fatal. Aspiration pneumonia is estimated to occur in 5% to 15% of patients with communityacquired pneumonia. Chemical pneumonitis, bacterial pneumonia, or airway obstruction can occur. Having food, drink, or saliva spit from your mouth go into your lungs can also cause aspiration pneumonia. Aspiration pneumonitis and pneumonia are caused by inhaling toxic substances, usually gastric contents, into the lungs. The condition can be caused by bacteria that normally reside in the mouth or nasal passages, or. Aspiration is a common event, and as many as half of all adults aspirate during sleep.
Early empirical treatment is required for cases that are severe enough to warrant hospitalisation. Individuals with aspiration pneumonia may need to receive supplemental oxygen as part of their treatment regimen. Aspiration pneumonia is a lung infection that occurs when relatively large amount of material such as food, saliva, liquids or vomit from the stomach or mouth, enter into the lungs. Cap is an infection of the pulmonary parenchyma acquired outside of a health care setting. Aspiration pneumonia is a severe type of the inflammation of the pulmonary tissues. If pulse oximetry and cardiac monitoring do not indicate the necessity for full intubation with a breathing machine, the patient will receive supplemental oxygen through a nasal tube or. Pneumonia is a breathing condition in which there is inflammation swelling or an infection of the lungs or large airways. What is the initial treatment of aspiration pneumonia. Bacteremic pneumococcal pneumonia should be treated for a minimum renalof 1014 days. Microbiology of severe aspiration pneumonia in institutionalized elderly. Chest physiotherapy for pneumonia in adults pneumonia is one of the most common health problems affecting all age groups around the world. The management of communityacquired pneumonia in infants and children older than 3 months of age pdf icon 52.
Initial treatment of patients with suspected aspiration pneumonia without risk factors for anaerobic involvement should mirror the treatment of communityacquired pneumonia. Degree of injury increases with gastric acidity significant if gastric ph aspiration pneumonia is a lung infection that causes inflammation and buildup of fluid. Necrotizing pneumonia an overview sciencedirect topics. Someone with aspiration pneumonia may show symptoms of poor oral hygiene and throat clearing or wet coughing after eating. Necrotizing pneumonia in an otherwise healthy child usually resolves with antimicrobial treatment, but occasionally can progress to formation of pneumatoceles blebs in the lung parenchyma created by coalescence of alveolar spaces after rupture of septa, lung abscess, or bronchopleural fistula. Treatment hemodynamically stable patients with aspiration events o antibiotics are not warranted, and supportive care is the mainstay of therapy. Pneumonia management and prevention guidelines cdc. Practice guidelines are systematically developed statements to assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances. A prospective evaluation using a protected specimen brush and quantitative. Aspiration pneumonia is a common problem in older people with high mortality and increasing prevalence. Aspiration that has resulted in pneumonia, lung abscess, or empyema caused by oropharyngeal anaerobic bacteria has usually been treated, at least initially, with penicillin. Antibacterial treatment of aspiration pneumonia in older.
Aspiration increases your risk for aspiration pneumonia. Germs bacteria introduced by this route set up an infection of the lung tissue, resulting in pneumonia. This category is located between communityacquired pneumonia and hospitalacquired pneumonia. Diagnosis and treatment of adults with communityacquired pneumonia. Many cases of nosocomial pneumonia are aspiration related. Aspiration pneumonia can lead to the development of necrotizing pneumonia or lung abscess, which may require a prolonged course of antibiotics and surgery. An official clinical practice guideline of the american thoracic society and infectious diseases society of america. Two pathways with different empiric treatment regimens based on risk of infection with multidrugresistant mdr pathogens including mrsa, pseudomonas spp.
Your risk is highest if you are older than 75 or live in a nursing home or longterm care center. A common cause of aspiration pneumonia is inhaling aspirating acid or vomit from the stomach. In contrast to chemical pneumonitis, antibiotics are the most important component in the treatment of aspiration pneumonia. Aspiration pneumonitis and pneumonia pulmonary disorders. Aspiration pneumonitis chemical pneumonitis chemical aspiration of acidic gastric contents. The management of communityacquired pneumonia in infants and children older than 3 months of age pdf icon 52 pages external icon. Symptoms may come on slowly, but if you dont get treatment, they can get worse and become life. Aspiration pneumonia most often develops due to micro aspiration of saliva, or bacteria carried on food and liquids, in combination with impaired host immune function.