Characteristics of aspiration pneumonia patients in acute care hospitals: A multicenter, retrospective survey in Northern Japan

Abstract

Background Pneumonia is a common cause of illness and death of the elderly in Japan. Its prevalence is escalating globally with the aging of population. To describe the latest trends in pneumonia hospitalizations, especially aspiration pneumonia (AP) cases, we assessed the clinical records of pneumonia patients admitted to core acute care hospitals in Miyagi prefecture, Japan. Methods A retrospective multi-institutional joint research was conducted for hospitalized pneumonia patients aged ≥20 years from January 2019 to December 2019. Clinical data of patients were collected from the medical records of eight acute care hospitals. Results Out of the 1,800 patients included in this study, 79% of the hospitalized pneumonia patients were aged above 70 years. The most common age group was in the 80s. The ratio of AP to total pneumonia cases increased with age, and 692 out of 1,800 patients had AP. In univariate analysis, these patients had significantly older ages, lower body mass index (BMI), a lower ratio of normal diet intake and homestay before hospitalization, along with more AP recurrences and comorbidities. During hospitalization, AP patients had extended fasting periods, more swallowing assessments and interventions, longer hospitalization, and higher in-hospital mortality rate than non-AP patients. A total of 7% and 2% AP patients underwent video endoscopy and video fluorography respectively. In multivariate analysis, lower BMI, lower C-reactive protein, a lower ratio of homestay before hospitalization, a higher complication rate of cerebrovascular disease, dementia, and neuromuscular disease were noted as a characteristic of AP patients. Swallowing interventions were performed for 51% of the AP patients who had been hospitalized for more than two weeks. In univariate analysis, swallowing intervention improved in-hospital mortality. Lower AP recurrence before hospitalization and a lower ratio of homestay before hospitalization were indicated as characteristics of AP patients of the swallowing intervention group from multivariate analysis. Change in dietary pattern from normal to modified diet was observed more frequently in the swallowing intervention group. Conclusion AP accounts for 38.4% of all pneumonia cases in acute care hospitals in Northern Japan. The use of swallowing evaluations and interventions, which may reduce the risk of dysphagia and may associate with lowering mortality in AP patients, is still not widespread.

Aspiration pneumonia

“…Currently, microorganism such as Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Enterobacteriaceae are the most common organisms. In a recent retrospective multi-institutional joint research from Japan were 1,800 patients with pneumonia were included, the ratio of aspiration pneumonia to total pneumonia cases increased with age, and 38% of the patients had aspiration pneumonia [11]. There were significant differences between the microbial etiology between patients with aspiration pneumonia and patients without aspiration pneumonia, with a higher frequency of S. aureus, Klebsiella spp., and Escherichia coli, and a lower frequency of S. pneumoniae, and H. influenzae in the aspiration group.…”

“…Microaspiration is recognized as the main pathogenic mechanism in pneumonia where particulate material and microorganisms are able to enter upper airways and then reach the lower airways and respiratory tract; while macroaspiration which refers to the aspiration of a large-volume of oropharyngeal or upper gas-trointestinal content passing through the trachea and larynx into the lungs describes the term "aspiration pneumonia" [1]. Approximately, between 10% to 30% of hospitalized patients with a diagnosis of community-acquired pneumonia have an illness related to aspiration [2][3][4]. However, numbers related to aspiration in patients with hospital-acquired pneumonia are scarce.…”

Dental and Oral Care Model for Inpatients to Prevent the Occurrence of Hospital Acquired Pneumonia (HAP) in the Elderly in the Geriatric Room of Mukomuko Hospital Bengkulu Province

“…The incidence in cases of Community Acquired Pneumonia (CAP) and HAP was 60.1%, 86.7% and Aspiration Pneumonia (AP) accounted for 66.8% of the total pneumonia inpatients. This number is closely related to patients aged 65 years as many as 22 ,1% in 2018 (Suzuki et al, 2021). Nonventilator Hospital Acquired Pneumonia (NV-HAP) risk is noticed higher when the patients stay increases.…”

Early platelet level reduction as a prognostic factor in intensive care unit patients with severe aspiration pneumonia

“…Recent researches on the inflammatory biomarker procalcitonin (PCT) and new blood biomarkers, for example, NLR (neutrophilic granulocyte/lymphocyte ratio) and PLR (platelet cell count/lymphocytes) are also being used. A recent multicenter retrospective study in northern Japan found that, compared with non-AP, AP patients have lower BMI (19.4 ± 4.0 vs. 21.4 ± 4.6), C-reactive protein (9.4 ± 8.5 vs. 11.5 ± 9.8 mg/dL), and serum albumin (3.1 ± 0.6 vs. 3.2 ± 0.6) g/dL); higher rates of cerebrovascular disease, dementia and neuromuscular disease complications; and higher mortality rates ( Suzuki et al, 2021 ).…”