Spectrum: Local Antimicrobial Stewardship, for Fraser Health

Aspiration Pneumonia

Microbiology

  • Aspiration pneumonitis is a sterile chemical inflammatory process caused by aspiration of gastric acid. Antibiotics are NOT indicated in aspiration pneumonitis

  • The vast majority of aspiration pneumonia cases are indistinguishable from CAP and HAP – with respect to presentation, microbiology, and therapy

  • Classic aspiration pneumonia has a protracted onset with putrid sputum and often a lung abscess or empyema. Anaerobes play a larger role in classic aspiration pneumonia

Diagnosis

The diagnosis of pneumonia is based on suggestive clinical features (cough, fever, sputum production, pleuritic chest pain, dyspnea) AND a new chest x-ray infiltrate

Pneumonia takes several days to develop after an aspiration event

All patients with suspected aspiration pneumonia should have a chest X-ray. Sputum culture should be collected if risk factors for antibiotic resistant organisms are present

Empiric Treatment

Witnessed aspiration event

Aspiration pneumonitis

Aspiration pneumonia

Anaerobes unlikely

Majority of cases lacking criteria of classic aspiration pneumonia below.

Classic aspiration pneumonia

Anaerobes likely:

  • subacute onset

  • putrid sputum

  • lung abscess, necrotizing pneumonia, or empyema

Oral Step-Down and Duration