Aspiration pneumonia: A review of modern trends

• Published in: Journal of critical care 2015-02, Vol.30 (1), p.40-48
• Main Authors: DiBardino, David M., MD, Wunderink, Richard G., MD
• Format: Article
• Language: English
• Subjects: Airway management; Anaerobic infection; Anti-Bacterial Agents - therapeutic use; Antibiotics; Aspiration; Aspiration pneumonia; Asthma; Bacteria, Aerobic; Bacteria, Anaerobic; Critical Care; Cross Infection - classification; Cross Infection - diagnosis; Cross Infection - etiology; Cross Infection - therapy; Diagnosis, Differential; E coli; Experiments; Humans; Hydrochloric acid; Lung abscess; Lungs; Microbiology of pneumonia; Mortality; Older people; Patients; Pneumonia; Pneumonia - diagnosis; Pneumonia - drug therapy; Pneumonia - etiology; Pneumonia, Aspiration - diagnosis; Pneumonia, Aspiration - drug therapy; Pneumonia, Aspiration - etiology; Pneumonia, Aspiration - prevention & control; Pulmonary fibrosis; Respiratory distress syndrome; Risk Factors; Streptococcus infections; Studies; Terminology as Topic; Trends
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2014.07.011

Abstract Purpose The purpose was to describe aspiration pneumonia in the context of other lung infections and aspiration syndromes and to distinguish between the main scenarios commonly implied when the terms aspiration or aspiration pneumonia are used. Finally, we aim to summarize current evidence surrounding the diagnosis, microbiology, treatment, risks, and prevention of aspiration pneumonia. Materials and methods Medline was searched from inception to November 2013. All descriptive or experimental studies that added to the understanding of aspiration pneumonia were reviewed. All studies that provided insight into the clinical aspiration syndromes, historical context, diagnosis, microbiology, risk factors, prevention, and treatment were summarized within the text. Results Despite the original teaching, aspiration pneumonia is difficult to distinguish from other pneumonia syndromes. The microbiology of pneumonia after a macroaspiration has changed over the last 60 years from an anaerobic infection to one of aerobic and nosocomial bacteria. Successful antibiotic therapy has been achieved with several antibiotics. Various risks for aspiration have been described leading to several proposed preventative measures. Conclusions Aspiration pneumonia is a disease with a distinct pathophysiology. In the modern era, aspiration pneumonia is rarely solely an anaerobic infection. Antibiotic treatment is largely dependent on the clinical scenario. Several measures may help prevent aspiration pneumonia.