Aspiration pneumonia and pneumonitis: Difference between revisions

Revision as of 22:47, 30 August 2017

Difficult to predict which patients with pneumonitis will go on to develop pneumonia
Aspiration pneumonitis
- Inflammatory chemical injury of tracheobronchial tree and pulmonary parenchyma
- Due to inhalation of regurgitated sterile gastric contents
- Must aspirate at least 20-30mL of gastric contents with pH <2.5
- Can lead to aspiration pneumonia due to pulmonary defense mechanism injury
Aspiration pneumonia
- Alveolar space infection secondary to inhalation of pathogenic material from oropharynx
- Increased in patients with periodontal disease, chronic colonization of upper airways, or taking PPI/H2-blockers
- Accounts for up to 20% of community-acquired pneumonia in elderly, majority of nursing home-acquired pneumonia
- Microbiology
  - Community acquired: Pneumococcus, staph, H flu, enterobacter
  - Hospital acquired: Pseudomonas, gram-negatives

Aspiration pneumonia
- Fever
- Dyspnea
- Productive cough
- Tachypnea
- Tachycardia
- altered mental status
Aspiration pneumonitis
- Cough
- Tachypnea
- Bloody sputum
- Respiratory distress

CXR
- Unilateral focal or patchy consolidations in dependent lung segments
- Right lower lobe is most common area; bilateral patterns can also be seen
- Lower lobe infiltrate when aspiration occurs in upright position
- Upper lobe infiltrate when aspiration occurs in recumbent position
CT
- Increased sensitivity, specificity, and overall accuracy compared to CXR
- Reasonable to obtain even if CXR negative if clinical suspicion is high

Aspiration pneumonitis
- Suction upper airway if aspiration is witnessed
- Antibiotics
  - Only recommended if symptoms persist >48hr
    - Levo/moxifloxacin or clindamycin or amoxicillin-clavulanate
Aspiration pneumonia
- Community-acquired
  - Moxifloxacin OR clindamycin OR amoxicillin-clavulanate
- Health care-associated or periodontal disease or alcoholism
  - Ceftriaxone + clindamycin OR
  - Piperacillin-tazobactam + clindamycin OR
  - Ampicillin-sulbactam + clindamycin OR
  - Cefepime + clindamycin OR
  - Levofloxacin + clindamycin

Admit all patients with aspiration pneumonia
For aspiration pneumonitis, consider discharge if:
- Otherwise healthy and non-toxic
- Give outpatient antibiotics if symptomatic for >48hrs
For aspiration pneumonitis, consider admission for:
- Chronically ill or immunocompromised
- Nursing home patient

Authors:

@@ Line 50: / Line 50: @@
 *Aspiration pneumonia
 **Community-acquired
-***[[Moxifloxacin]] or [[clindamycin]] or [[amoxicillin-clavulanate]]
+***[[Moxifloxacin]] '''OR''' [[clindamycin]] '''OR''' [[amoxicillin-clavulanate]]
 **Health care-associated or periodontal disease or alcoholism
 ***[[Ceftriaxone]] + clindamycin '''OR'''
@@ Line 59: / Line 59: @@
 ==Disposition==
-*Healthy person
-**Observe for 1hr; if asymptomatic, discharge
-**If mild-moderate symptoms develop and persist >48hr, treat with antibiotics
-*Chronically ill or nursing home patient:
-**Consider ED obs unit versus short admission for observation +/- prophylactic antibiotic
 *Admit all patients with aspiration pneumonia
+*For aspiration pneumonitis, consider discharge if:
+**Otherwise healthy and non-toxic
+**Give outpatient antibiotics if symptomatic for >48hrs
+*For aspiration pneumonitis, consider admission for:
+**Chronically ill or immunocompromised
+**Nursing home patient
 ==See Also==
@@ Line 71: / Line 72: @@
 ==References==
 <References/>
 [[Category:ID]]
 [[Category:Pulmonary]]