Spectrum: Local Antimicrobial Stewardship, for Island Health

HA Aspiration Pneumonia

Duration of Therapy

Variable

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

Piperacillin/tazobactam 4.5g IV Q6H

OR, IF Immunocompromised or known ESBL/AmpC

Meropenem 1g IV Q8H

IF AT RISK FOR MRSA ADD

MRSA Risk Factors

  • Known colonization

  • Necrotizing pneumonia

  • Recent influenza

  • Injection drug use

  • Broad spectrum antibiotic use in last 90 days

Vancomycin 25mg/kg BOLUS, then use high target trough nomogram

De-escalate

Stop vancomycin if MRSA absent from culture/screening swabs

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

Choose culture-directed treatment

Therapy Pearls

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

Staph aureus

E. coli

Klebsiella pneumoniae

Oral streptococci

Early Aspiration (< 5 days of hospitalization)

Streptococcus pneumoniae

Haemophilus influenzae