Aspiration pneumonia bacterial infection: Difference between revisions

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{{Pneumonia}}
__NOTOC__
'''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh@perfuse.org]
{{Aspiration pneumonia bacterial infection}}
==Overview==
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
[[Aspiration pneumonia]] caused by bacterial infection is the commonest subtype of [[aspiration pneumonia]]. The other subtypes being [[chemical pneumonia]], and airway obstructions.


==Causes==
{{CMG}}; {{AE}} [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com]
* Normal flora of upper airways, gingival cavity or stomach.
* Caused by less virulent bacteria, such as aerobic or microaerophilic [[streptococci]] (commonest) and anaerobes (second common cause) such as
** [[Peptostreptococcus]]
** [[Fusobacterium nucleatum]]
** [[Prevotella]]
** [[Bacteroides]]


==Diagnosis==
==[[Aspiration pneumonia bacterial infection overview|Overview]]==
==History and symptoms==
===The manifestation depends on:===
* The bacteria involved
* Time since aspiration to diagnosis
* Immune status of the host
===Symptoms in aerobic microbes===
* Abrupt or Indolent course
* Productive [[cough]]
* [[Fever]]
* Absence of [[chills]] and [[rigors]]
* [[Dyspnea]]
* [[Anorexia]], weight loss
* [[Anemia]]


==Lab diagnosis==
==[[Aspiration pneumonia bacterial infection pathophysiology|Pathophysiology]]==
===Sputum culture===
* Expectorated sputum is not used as an diagnostic tools as contamination by the normal flora of the mouth and airways is inevitable.
* Specimen obtained via bronchoscopy may be suitable but limited studies are available to prove this.
===Symptoms in anaerobic microbes===
Clinical features, which are characteristic of aspiration pneumonia involving anaerobic bacteria, include:


* Indolent course
==[[Aspiration pneumonia bacterial infection causes|Causes]]==
* Presence of risk factors: altered sensorium (anesthesia, alcohol, drug, trauma, dysphagia, dental caries)
* Putrid sputum
* Absence of chills and rigors


==Chest X Ray==
==[[Aspiration pneumonia bacterial infection differential diagnosis|Differentiating Aspiration pneumonia bacterial infection from other Diseases]]==
* Lung abscess
* Empyema
* Involvement of dependent pulmonary lobes i.e., upright position lower lobe, superior segment of lower lobes or posterior segment of upper lobes in recumbent position


==Natural History, Complications and Prognosis==
==[[Aspiration pneumonia bacterial infection risk factors|Risk factors]]==
* Lung abscess
 
* Necrotizing pneumonia
==[[Aspiration pneumonia bacterial infection natural history, complications, and prognosis|Natural History, Complications and Prognosis]]==
* Empyema
 
* Bronchopleural fistula
==Diagnosis==
[[Aspiration pneumonia bacterial infection history and symptoms| History and Symptoms]] | [[Aspiration pneumonia bacterial infection physical examination | Physical Examination]] |  [[Aspiration pneumonia bacterial infection chest x ray|Chest X Ray]] |  [[Aspiration pneumonia bacterial infection ct scan | CT scan ]]


==Risk factors==
* Poor dental hygiene is a risk factor
* Patients with good dental hygiene and edentulous are less predisposed
==Treatment==
==Treatment==
===Medical therapy===
[[Aspiration pneumonia bacterial infection medical therapy|Medical Therapy]]
====Antibiotics====
[[Category:Diseaase]]
* Treatment of choice [[clindamycin]]
[[Category:Pulmonology]]
* Doses 600 mg BID
* Other agents used: Ampicillin-sulbactam (1.5 g or 3 g twice daily), Imipenem (Invanz 500 mg BID), amoxicillin-clavulnate, penicillin + metronidazole.
* Monotherapy with metronidazole is not preferred as high failure rates have been reported. This is because metronidazole is ineffective against some pathogens such as microaerophilic and aerobic streptococci


* Advantage of clindamycin :
[[Category:Aspiration pneumonia bacterial infection|Aspiration pneumonia bacterial infection]]
 
[[Category:Emergency medicine]]
** Cheap
** Less incidences of superimposed [[MRSA]]


==References==
==References==
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[[Category:Diseaase]]
[[Category:Diseaase]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Infectious disease]]
 
[[Category:Pneumonia|Pneumonia]]
[[Category:Pneumonia|Pneumonia]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]

Latest revision as of 17:02, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.D. [2]

Overview

Pathophysiology

Causes

Differentiating Aspiration pneumonia bacterial infection from other Diseases

Risk factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Chest X Ray | CT scan

Treatment

Medical Therapy

References

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