II. Definitions
- Aspiration Pneumonia
- Pneumonia due to food, liquid or gastric contents aspirated into the upper respiratory tract
- Aspiration Pneumonitis (chemical pneumonitis)
- Chemical aspiration of acidic gastric contents
- Degree of injury increases with gastric acidity (significant if gastric pH<2.5)
- With normal gastric acidity, Stomach contents are typically sterile
- However, not sterile in Antacid use, enteral feeding, Gastroparesis, poor Dentition and Small Bowel Obstruction
- Chemical aspiration of acidic gastric contents
III. Epidemiology
- Represents <15% of all Community Acquired Pneumonia
IV. Risk Factors
- Underlying Neurologic disease or Impairment (esp. depressed gas reflex)
- Esophageal dysfunction
- Anesthesia complication
- Microaspiration in Sleep Apnea
- Poor Dentition or severe gum disease
V. Etiology: Anaerobic Bacteria or Mixed oropharyngeal flora
- Bacteroides
- Peptostreptococcus
- Microaerophilic Streptococcus
- Fusobacterium
- Nocardia
VI. Pathophysiology
- Necrotizing infection may lead to cavitation
- Affects dependent lung lobes
VII. Symptoms
- Low grade fever
- Weight loss
- Productive cough with foul smelling Sputum
VIII. Signs
- Hypoxemia
- Tachypnea with Respiratory Alkalosis
- Wheezing
- Pulmonary Rales
- Hypotension
IX. Labs
-
Sputum Gram Stain unreliable
- Typically demonstrates mixed oral flora and many PMNs
- Sputum Culture unreliable
X. Imaging
- Chest XRay (often negative initially)
XI. Management: General
- Initial aspiration event results in chemical pneumonitis (not Pneumonia)
- When this is witnessed (e.g. under Anesthesia, Endotracheal Intubation), do not immediately start Antibiotics
- Await the development of Pneumonia (fever, symptoms) to institute Antibiotics
- Empiric Antibiotic prophylaxis after witnessed aspiration results in worse outcomes (e.g. Antibiotic Resistance)
- Consider early Antibiotics in Antacid use, enteral feeding, Gastroparesis and Small Bowel Obstruction
-
Antibiotics
- Typical Pneumonia organisms are more common than Anaerobes even in patients at aspiration risk
- Consider starting with typical Community Acquired Pneumonia Management
- However, start with anaerobic coverage if poor Dentition or gum disease
- Add anaerobic coverage if failure to respond to initial Antibiotics
- Antibiotic course for up to 3-4 weeks
- Extend Antibiotic course up to 2-3 months for Lung Abscess
- Typical Pneumonia organisms are more common than Anaerobes even in patients at aspiration risk
XII. Management: Oral Antibiotics
- Start with typical Community Acquired Pneumonia Management (see above)
- Consider Antibiotics listed here if failure to respond to other first-line Antibiotics (or poor Dentition or gum disease)
- First-Line
- Clindamycin 300-450 mg orally three times daily
- Moxifloxacin 400 mg once daily
- Alternative
- Amoxicillin-Clavulanate 875 orally twice daily
XIII. Management: ParenteralAntibiotics
- tart with typical Community Acquired Pneumonia Management (see above)
- First Line
- Ceftriaxone 1 g IV every 24 hours AND Metronidazole 500 mg IV every 6 hours (or 1 g IV every 12 hours) OR
- Ampicillin-Sulbactam 3 g IV every 6 hours
- Alternative
- Piperacillin-Tazobactam (Zosyn) 3.375 g IV every 6 hours OR
- Ertapenem 1 g IV every 24 hours
XIV. Prevention
- Evaluate with Swallowing Exam
- Dysphagia Diet for moderate to severe Dysphagia
XV. Prognosis: Predictors of worse outcomes
- Lower pH (<2.5)
- Larger volume aspiration (>25 ml)
- Particulate matter aspirated (e.g. food)
- Bacterial contamination (esp. Anaerobic Bacteria)
XVI. References
- (2019) Presc Lett 26(9):50
- Swadron (2019) Pulmonology 2, CCME Emergency Medicine Board Review, accessed 6/16/2019
- Gilbert (2016) Sanford Antimicrobial, accessed IOS app 12/6/2016
- Lomotan (1997) Postgrad Med 102(2):225-31 [PubMed]
- Sasaki (1997) Intern Med 36(12):851-5 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSH) | A type of lung inflammation resulting from the aspiration of food, liquid, or gastric contents into the upper RESPIRATORY TRACT. |
| Concepts | Pathologic Function (T046) |
| MSH | D011015 |
| ICD10 | J69.0 |
| SnomedCT | 422588002, 47839005 |
| LNC | LA7415-8 |
| English | Aspiration Pneumonias, Pneumonia, Aspiration, Pneumonias, Aspiration, ASPIRATION PNEUMONIA, Aspiration pneumonitis, Aspiration pneumonia, Inhalation pneumonia, Aspiration pneumonia (disorder), aspiration pneumonia (diagnosis), aspiration pneumonia, Pneumonia aspiration, Inhalational pneumonia, pneumonia, inhalation, Aspiration pneumonia NOS, Pneumonia, Aspiration [Disease/Finding], Pneumonia;aspiration, inhalation pneumonia, aspiration pneumonitis, pneumonia aspiration, pneumonia; aspiration, Aspiration pneumonia, NOS, Aspiration Pneumonia |
| Dutch | aspiratie pneumonie, pneumonie; aspiratie, aspiratiepneumonie, Aspiratiepneumonie, Pneumonie, aspiratie- |
| French | Pneumonie par aspiration, Pneumopathie de déglutition, Pneumonie de déglutition, Bronchopneumopathie de déglutition, Pneumopathie d'inhalation, Pneumopathie par régurgitation |
| German | Inhalationspneumonie, Aspirationspneumonie, Pneumonie, Aspirations- |
| Italian | Polmonite da inalazione, Polmonite da aspirazione |
| Portuguese | Pneumonia por inalação, Pneumonia por Aspiração, Pneumonia por aspiração, Pneumonia Aspirativa |
| Spanish | Neumonía por inhalación, Neumonía inhalatoria, neumonía por aspiración, neumonía por inhalación, neumonía por aspiración (trastorno), neumonía aspirativa, neumonía aspirativa (trastorno), Neumonía por aspiración, Neumonía por Aspiración |
| Japanese | 吸入性肺炎, ｷｭｳﾆｭｳｾｲﾊｲｴﾝ, 酸吸引症候群, 吸引性肺炎, 誤嚥性肺炎, 吸引肺炎, 肺炎-誤嚥性, 肺炎-吸引性, 誤飲性肺炎, ｺﾞｴﾝｾｲﾊｲｴﾝ, 嚥下性肺炎, 肺炎-嚥下性 |
| Swedish | Aspirationspneumoni |
| Finnish | Aspiraatiokeuhkokuume |
| Russian | MENDEL'SONA SINDROM, ASPIRATSIONNAIA PNEVMONIIA, ASPIRATSIIA SODERZHIMOGO ZHELUDKA, PNEVMONIIA ASPIRATSIONNAIA, АСПИРАЦИОННАЯ ПНЕВМОНИЯ, АСПИРАЦИЯ СОДЕРЖИМОГО ЖЕЛУДКА, МЕНДЕЛЬСОНА СИНДРОМ, ПНЕВМОНИЯ АСПИРАЦИОННАЯ |
| Czech | Pneumonie aspirační, Inhalační pneumonie, Aspirační pneumonie, aspirační pneumonie, pneumonie aspirační |
| Polish | Zespół Mendelsona, Zapalenie płuc zachłystowe, Zapalenie płuc aspiracyjne |
| Hungarian | Aspiratiót követő pneumonia, Inhalatios pneumonia, Aspiratiós pneumonia |
| Norwegian | Aspirasjonspneumoni |
Ontology: Pneumonitis due to inhalation of food or vomitus (C0260334)
| Concepts | Disease or Syndrome (T047) |
| ICD9 | 507.0 |
| ICD10 | J69.0 |
| SnomedCT | 196036007, 196032009 |
| English | Pneumonitis due to inhalation of food or vomitus NOS, Pneumonitis-food/vomit NOS, Pneumonitis-food/vomit inhal., Pneumonitis due to food and vomit, Pneumonitis due to inhalation of food or vomit, Food/vomit pneumonitis, Pneumonitis due to inhalation of food or vomitus NOS (disorder), Pneumonitis due to inhalation of food or vomitus, Pneumonitis due to inhalation of food or vomitus (disorder) |
| Dutch | pneumonitis door aspiratie van voedsel of braaksel, Pneumonitis door voedsel en braaksel |
| French | Pneumonite due à l'inhalation de nourriture ou de vomi, Pneumopathie due à l'inhalation d'aliments ou vomissures |
| German | Pneumonitis durch Inhalation von Essen oder Erbrochenem, Pneumonie durch Nahrung oder Erbrochenes |
| Italian | Polmonite da inalazione di cibo o vomito |
| Portuguese | Pneumonite por aspiração de alimentos ou vómitos |
| Spanish | Neumonitis por aspiración de comida o vómitos, neumonitis debida a inhalación de comida o vómitos, SAI, neumonitis debida a inhalación de comida o vómitos, SAI (trastorno), neumonitis por inhalación de alimento o vómito (trastorno), neumonitis por inhalación de alimento o vómito |
| Japanese | 食物または吐物の吸引による肺臓炎, ｼｮｸﾓﾂﾏﾀﾊﾄﾌﾞﾂﾉｷｭｳｲﾝﾆﾖﾙﾊｲｿﾞｳｴﾝ |
| Czech | Pneumonitida z aspirace potravy nebo zvratků |
| Korean | 음식 또는 구토물에 의한 폐렴 |
| Hungarian | Élelem vagy hányás-inhalatio okozta pneumonitis, Étel- vagy hányás-inhalatio okozta pneumonitis |
