Aspiration Pneumonia/Pneumonitis
HA Aspiration Pneumonia

HA Aspiration Pneumonia

Duration of Therapy

Patients who recover within 24-48 hours likely had aspiration pneumonitis and should have their antibiotics stopped

7 days for true aspiration pneumonia

May require prolonged therapy (3-4 weeks or until resolved) if lung abscess develops

Empiric Therapy

OR, IF Immunocompromised or known ESBL/AmpC

IF AT RISK FOR MRSA ADD

  • Known colonization
  • Necrotizing pneumonia
  • Recent influenza
  • Injection drug use
  • Broad spectrum antibiotic use in last 90 days

De-escalate

Stop vancomycin if MRSA absent from culture/screening swabs

If no pseudomonas isolated, can narrow coverage or use non-anti-pseudomonal doses

Cultures are helpful in guiding therapy, especially if organisms are present on the gram stain

Refrain from treating candida in the sputum unless suspecting systemic candidiasis (e.g. neutropenic, transplant patients)

Cultures may continue to be positive despite treatment in ventilated patients; refrain from re-culturing if patient improving

Microbiology

Usual pathogens

Early Aspiration (< 5 days of hospitalization)