Is penicillin G an adequate initial treatment for aspiration pneumonia ? A prospective evaluation using a protected specimen brush and quantitative cultures

• Published in: Intensive care medicine 1993-05, Vol.19 (5), p.279-284
• Main Authors: MIER, L, DREYFUSS, D, DARCHY, B, LANORE, J. J, DJEDAÏNI, K, WEBER, P, BRUN, P, COSTE, F
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Asepsis - instrumentation; Biological and medical sciences; Bronchoscopes; Community-Acquired Infections - diagnosis; Community-Acquired Infections - drug therapy; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Comorbidity; Cross Infection - diagnosis; Cross Infection - drug therapy; Cross Infection - epidemiology; Cross Infection - microbiology; Digestive System Diseases - epidemiology; Drug Resistance, Microbial; Female; Hospital Mortality; Humans; Infusions, Intravenous; Length of Stay - statistics & numerical data; Male; Medical sciences; Middle Aged; Penicillin G - pharmacology; Penicillin G - therapeutic use; Pharmacology. Drug treatments; Pneumonia, Aspiration - diagnosis; Pneumonia, Aspiration - drug therapy; Pneumonia, Aspiration - epidemiology; Pneumonia, Aspiration - microbiology; Prognosis; Prospective Studies; Respiration, Artificial - statistics & numerical data; Specimen Handling - instrumentation
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/BF01690548

To evaluate the bacteriology of early aspiration pneumonia using a protected specimen brush and quantitative culture techniques, and whether penicillin G is adequate as initial treatment pending culture results. 52 patients (of which 45 required mechanical ventilation) meeting usual clinical criteria for aspiration pneumonia were prospectively included. On admission, patients were given intravenous penicillin G and a protected specimen brush was performed < or = 48 h after. Cultures of the brush were negative (< 10(3) CFU/ml) in 33 patients (1 had blood cultures positive with S. pneumoniae) and positive (> or = 10(3) CFU/ml) for S. pneumoniae in 2 patients. Seventeen patients had a positive culture (> or = 10(3) CFU/ml) for at least one penicillin G resistant microorganism, with a total of 20 organisms (S. aureus: 6; H. influenzae: 2; Enterobacteriaceae: 8; P. aeruginosa: 3; C. albicans: 1). In 4 of these patients, a penicillin-sensitive pathogen was also recovered in significant concentrations (S. pneumoniae: 2; Streptococcus sp.: 2). These 17 patients with a resistant pathogen did not differ from the 35 other patients with respect to need for ventilatory support and mortality rate. By contrast, they were older (61.1 +/- 21.9 vs. 42.9 +/- 18.8 years; p < 0.005) and required longer mechanical ventilation (6.1 +/- 4.6 vs. 3.5 +/- 2.7 days; p < 0.03) and hospitalization (11.2 +/- 8.8 vs. 6.7 +/- 4.7 days; p < 0.02). Of 17 patients 12 with penicillin G resistant organisms versus 0/35 without, were in-hospital patients and/or had a digestive disorder (p < 0.001). The broad range of offending organisms seen in early aspiration pneumonia precludes use of any single empiric regimen, making protected specimen brush mandatory in many patients. Nevertheless, the involvement of S.pneumoniae in a notable proportion of our patients suggests that routine penicillin prophylaxis after early aspiration (at least in most patients with community-acquired aspiration) is warranted given the potential severity of pneumococcal sepsis in such patients.