Critical Care: Multicenter Treatment and Outcome Evaluation of Aspiration Syndromes in Critically III Patients

Abstract

Antimicrobial agents are frequently prescribed to treat aspiration syndromes despite the lack of demonstrated efficacy for aspiration pneumonitis. Outcomes between aspiration syndromes were similar with the exception of duration of antibiotic treatment.

Are antibiotics indicated for the treatment of aspiration pneumonia?

“…17 This practice raises concerns of higher treatment costs and antibiotic resistance. 16,18,19 Additionally, antibiotics do not seem to alter the clinical outcome, including radiographic resolution, duration of hospitalization, or death rate, nor do they influence the subsequent development of infection. 1,11,13,20 In cases of witnessed or strongly suspected aspiration of gastric contents, antibiotics are not warranted since bacterial infection is not likely to be the cause of any signs or symptoms.…”

“…[11][12][13]15 empiric antibiotic treatment is controversial Chemical pneumonitis can be difficult to differentiate from bacterial aspiration pneumonia, and whether to give antibiotics is controversial. 16 A survey of current practices among intensivists showed that antimicrobial therapy was often given empirically for noninfectious chemical pneumonitis. 17 This practice raises concerns of higher treatment costs and antibiotic resistance.…”

“…1,11,13,20 In cases of witnessed or strongly suspected aspiration of gastric contents, antibiotics are not warranted since bacterial infection is not likely to be the cause of any signs or symptoms. 2,7,16 However, to detect secondary infection early, the patient's respiratory status should be monitored carefully and chest radiography should be repeated.…”

“…The causative organisms in community-acquired aspiration pneumonia are still debated despite abundant research. Older studies 1,24,25 found mostly anaerobic organisms (peptostreptococci, peptococci, Fusobacterium, Prevotela, Bacteroides) as the underlying pathogens, whereas more recent studies 16,26,27 found mostly aerobic organisms (Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Enterobacteriaceae) and failed to recover anaerobic organisms. These discrepancies may be the result of different techniques used to isolate organisms: older studies used transtracheal sampling, and transtracheal aspirates may be easily contaminated or colonized by oropharyngeal flora; more recent studies used protected specimen brushes to collect lower-airway specimens.…”

“…2 In addition, the pathogenic organisms that predominate in community-acquired aspiration pneumonia, as listed above, are different from those most often found in nosocomial cases; gram-negative bacilli (Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli) are most often isolated in patients with aspiration pneumonia acquired in hospitals and nursing homes. 16,27,28 S aureus also is an important causative organism in nosocomial cases. 16,28 for nosocomial bacterial aspiration pneumonia, start with a broad-spectrum antibiotic and adjust later dAOUd ANd GUzMAN Knowing the causative organisms in bacterial aspiration pneumonia is important for guiding antimicrobial therapy.…”