Aspiration Pneumonia/Pneumonitis

Aspiration Pneumonia/Pneumonitis

Refers to the development of radiographically evident infiltrate and respiratory symptoms 36-48 hours after aspiration of colonized oropharyngeal material

Risk Factors include:

  • decreased LOC
  • dysphagia
  • anatomic abnormality of upper GI tract
  • ET/NG tubes

Aspiration pneumonitis occurs within hours of aspiration often associated with a CXR infiltrate and impaired oxygenation

Aspiration pneumonitis per se does NOT require antibiotics

Aspiration pneumonia follows in only 1/4 of patients and generally occurs at least 36h after the aspiration event

Thus, reasonable to withhold treatment unless patients develop new signs of infection such as elevated WBC and fever at ~36-48h

In patients who are very ill with minimal physiologic reserve it is reasonable to treat aspiration pneumonitis with antibiotics to PREVENT subsequent pneumonia

Chest X-ray may be positive in pneumonitis; rapid improvement usually indicates lack of pneumonia

Blood and sputum cultures should be obtained in hospitalized/ED patients; noninvasive sampling is preferred

NP swabs for respiratory viruses (influenza, enterovirus, rhinovirus) are not recommended

There is little evidence for procalcitonin use to differentiate aspiration pneumonia from pneumontitis

Performing Legionella urine antigen and the Respiratory Pathogen Panel (RPP) are not recommended

If cavitary pneumonia develops consider TB, fungal pathogens and Nocardia

In immunocompromised patients consider opportunistic pathogens and an Infectious Disease Consult

Empiric Therapy

Acquired in a community setting or nursing home

Acquired 72 hours after admission to hospital