Microbiology of Severe Aspiration Pneumonia in Institutionalized Elderly

Abstract

We sought to investigate prospectively the microbial etiology and prognostic indicators of 95 institutionalized elders with severe aspiration pneumonia, and to investigate its relation to oral hygiene in using quantitative bronchial sampling. Data collection included demographic information, Activity of Daily Living, Plaque Index, antimicrobial therapy, and outcome. Out of the 67 pathogens identified, Gram-negative enteric bacilli were the predominant organisms isolated (49%), followed by anaerobic bacteria (16%), and Staphylococcus aureus (12%). The most commonly encountered anaerobes were Prevotella and Fusobacterium species. Aerobic Gram-negative bacilli were recovered in conjunction with 55% of anaerobic isolates. The Plaque Index did not differ significantly between the aerobic (2.2 +/- 0.4) and the anaerobic group (2.3 +/- 0.3). Functional status was the only determinant of the presence of anaerobic bacteria. Although seven cases with anaerobic isolates received initially inadequate antimicrobial therapy, six had effective clinical response. The crude mortality was 33% for the aerobic and 36% for the anaerobic group (p = 0.9). Stepwise multivariate analysis identified hypoalbuminemia (p < 0.001) and the burden of comorbid diseases (p < 0.001) as independent risk factors of poor outcome. In view of the rising resistance to antimicrobial agents, the importance of adding anaerobic coverage for aspiration pneumonia in institutionalized elders needs to be reexamined.

Incidence of Aspiration Pneumonia in Patients with Altered Consciousness Admitted in DMCH

“…9 Elsolh and Pietrantoni (2003) found dyspnea, fever, and delirium in the majority of patients in their study. 1 In present study all the patients had reduced consciousness. Stroke was found in 32 (64%) patients, encephalitis was found in 8 (16%) patients, hepatic encephalopathy was found in 8 (16%) patients and 2 patients had uremic encephalopathy.…”

“…Approximately 10% of patients who are hospitalized due to altered consciousness or drug overdose will have aspiration pneumonia. 1 Aspiration pneumonia is more common in extremely young and old patients and in males than females. 2 The mortality rate of aspiration pneumonia is approximately 1% in outpatient setting and upto 25% in those requiring hospitalization.…”

Sensory Stimulation to Improve Swallowing Reflex and Prevent Aspiration Pneumonia in Elderly Dysphagic People

“…Data about microbiological diagnosis of aspiration pneumonia are disparate for the following three reasons: First, several studies enrolled patients relatively late, when complications such as necrotizing pneumonia, lung abscess, or empyema had already occurred; and in these patients, anaerobic organisms were found to be the predominant pathogens isolated alone or with aerobes (10,11), whereas most common pathogens isolated in relatively early enrolled patients with aspiration pneumonia are Streptococcus pneumonia, gram-negative bacilli, anaerobes, and Staphylococcus aureus (12). Second, in many cases, it is impossible to isolate the responsible pathogens.…”

Evaluation of a Rapid Oral Bacteria Quantification System Using Dielectrophoresis and the Impedance Measurement

“…nucleatum is the coaggregating partner for P. gingivalis and may be present with P. gingivalis in the oral cavity Kinder and Holt, 1989 . P. gingivalis and F. nucleatum are common isolates from aspiration pneumonia Okuda, 2005;El-Solh et al, 2003 . Our result with these bacterial species demonstrated that the DEPIM method is useful for counting the number of coaggregated bacterial samples better than the culture method data not shown .…”