From the Guidelines
Aspiration pneumonia should be treated with prompt empiric antibiotic therapy.
Treatment Approach
The treatment approach for aspiration pneumonia involves the use of broad-spectrum antibiotics, with the selection of initial antibiotic therapy based on risk factors for specific pathogens, modified by knowledge of local patterns of antibiotic resistance and organism prevalence 1.
- The clinical strategy emphasizes prompt empiric therapy for all patients suspected of having aspiration pneumonia, as delay in the initiation of appropriate antibiotic therapy is associated with increased mortality 1.
- The choice of initial antibiotic therapy should be guided by the severity of illness, the presence of risk factors for specific pathogens, and knowledge of local antibiotic resistance patterns.
Diagnostic Considerations
- The diagnosis of aspiration pneumonia is based on the presence of a new or progressive radiographic infiltrate, plus at least two of three clinical features: fever, leukocytosis or leukopenia, and purulent secretions 1.
- Semiquantitative cultures of endotracheal aspirates or sputum can be used to guide initial empiric antibiotic therapy, with a reliably performed Gram stain of tracheal aspirates having a low incidence of inappropriate therapy 1.
Management
- Blood cultures, urine analysis with culture, and thoracentesis (if pleural effusion is present) should be considered as part of the routine care of patients suspected of having aspiration pneumonia 1.
- Antiatelectatic measures, such as increasing positive-end expiratory pressure and/or tidal volume, bronchodilators, and chest physical therapy including suctioning, may also be beneficial 1.
- The treatment should be modified based on the clinical response and the findings of semiquantitative cultures of lower respiratory tract secretions 1.
From the Research
Treatment Approaches
The treatment for aspiration pneumonia varies based on the site of acquisition, risk for multidrug-resistant organisms, and severity of illness.
- For community-acquired aspiration pneumonia (CAAP) patients without severe illness and with no risk for multidrug-resistant (MDR) organisms or Pseudomonas aeruginosa (PA), standard inpatient community-acquired pneumonia therapy covering anaerobes can be used 2.
- Patients with CAAP and risk factors for MDR pathogens, septic shock, need for an intensive care unit (ICU) admission, or mechanical ventilation can be considered for broader coverage against anaerobes, methicillin-resistant Staphylococcus aureus (MRSA), and PA 2.
- Severe aspiration pneumonia that originates in a long-term care facility or healthcare-associated aspiration pneumonia (HCAAP) with one or more risk factors for MDR organisms should be considered for similar treatment 2.
- HCAAP with one or more risk factors for MDR organisms or PA, plus septic shock, need for ICU admission or mechanical ventilation should receive double coverage for PA in addition to coverage for MRSA and anaerobes 2.
Management Strategies
Management of aspiration pneumonia includes:
- Removal of etiologic factors (drugs, tubes, mobilisation, oral hygiene) 3.
- Supportive care 3, 4.
- Specific antibiotic therapy for community-acquired or nosocomial events 3, 4, 2, 5, 6.
- Aggressive pulmonary care to enhance lung volume and clear secretions in cases of aspiration pneumonitis 4.
- Intubation should be used selectively 4.
- Early corticosteroids and prophylactic antibiotics are not indicated in cases of aspiration pneumonitis 4.
Antibiotic Therapy
Antibiotic treatment is largely dependent on the clinical scenario, and there is no ideal antibiotic regimen 4, 5.
- Unit-specific resistance patterns and known frequency pathogens should direct broad spectrum empiric therapy 4.
- Antibiotic coverage should be narrowed once sputum culture results become available 4.
- Treatment for aspiration pneumonia should include antibiotic coverage for oral anaerobes, aerobes associated with community-acquired pneumonia, and resistant organisms depending on appropriate clinical context 6.