Refers to the development of radiographically evident infiltrate and respiratory symptoms 36-48 hours after aspiration of colonized oropharyngeal material
Risk Factors include:
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
Acquired in a community setting or nursing home
Acquired 72 hours after admission to hospital