Pneumonia, Aspiration

[New Engl J Med 2019;380:651-63]

- Development of radiographically evident infiltrate following the aspiration of colonized oropharyngeal material.

Risk factors:

• decreased level of consciousness
• dysphagia
• anatomic abnormality of upper GI tract
• mechanical interference of GI tract (ET/NG tubes)

Clinical:

• usually older patient with above risk factors
• infiltrates in dependent lung segments, especially RLL
• episode of aspiration often not witnessed
• may progress to abscess/empyema within 1-2 weeks.

Etiology:

• role of anaerobes is controversial and may have been overemphasized in the past
• Gram stain may be helpful in diagnosis and decision to use antianaerobic therapy
• choice of antibiotic dependent on clinical situation
• ceftriaxone has activity against many oral anaerobes.

- For immunocompromised patients, recommend Infectious Diseases consult.