Aspiration pneumonia

List the common pathogens that cause community-acquired pneumonia, aspiration pneumonia, ventilator-associated pneumonia (early versus late onset), and health care-associated pneumonia. 

Design an appropriate empirical antimicrobial regimen based on patient-specific data for an individual with community-acquired pneumonia, aspiration pneumonia, and ventilator-... 

At less than 2% in the clinical investigations acute renal failure, atrial fibrillation, cerebrovascular accident, sepsis, meningitis, psychotic disorder, suicidal ideation, respiratory distress, rhabdomyolysis, electrocardiogram abnormal, stupor, loss of consciousness, incoherent, clonic convulsion and grand mal convulsion. Rare instances of fatal pneumonia aspiration and suicide attempt were reported (<1%). 

Torres A. Ventilator associated pneumonia, aspiration and sepsis. Abstracts of Papers, International Consensus Conference in Intensive Care Medicine Weaning from Mechanical Ventilation, Budapest, Hungary, April 28-29, 2005. Convened by five major scientific societies. 

Cefuroxime (35) is effective against community-acquired pneumonia in which ampicillin-resistant Haemophilus influence is the probable etiologic agent. Cefoxitin (23) is used to treat mixed aerobic—anaerobic infections including pelvic infections, intra-abdorninal infections, and nosocomial aspiration pneumonia. Cefonicid (31), because of its long half-life has been used in a once-a-day regimen to treat a variety of mild to moderate infections including community-acquired pneumonias, urinary tract infections, and infections of the skin and soft tissue (132,215). 

Ingestion of small amounts of tetrachloroethylene is not likely to cause permanent injury however, ingestion of large amounts may result in serious injury or even death. AH containers should be properly labeled. If solvent is swaHowed, consult a physician immediately. Do not induce vomiting. If solvent is aspirated it is rapidly absorbed through the lungs and may cause systemic effects and chemical pneumonia. 

Sarcoidosis, berylliosis, fulminating or disseminating pulmonary tuberculosis, aspiration pneumonia... 

Bronchospasm, aspiration pneumonia Anesthesia, somnolence, sleep... 

Some comatose patients are unconscious for less than 2 hours, do not show signs of severe toxicity, and have few complications. In other patients, coma lasts from 2 to 24 hours, and symptoms are more marked. Patients with severe toxicity, including status epi -lepticus and malignant hyperthermia, may remain in coma for 1 day to 3 weeks. These patients often have respiratory or metabolic acidosis. Comatose patients are susceptible to aspiration pneumonia and rhabdomyolysis. Head injury and intracerebral bleeding should be considered as the cause of the comatose state. 

Lubricant laxatives work by coating the stool, which allows it to be expelled more easily. The oily film covering the stool also keeps the stool from losing its water to intestinal reabsorption processes. Mineral oil (liquid petrolatum) is a non-prescription heavy oil that should be used with caution, if at all, since it may be aspirated into the lungs and cause lipoid pneumonia. This is of particular concern in the young or the elderly. 

There are five classifications of pneumonia community-acquired, aspiration, hospital-acquired, ventilator-associated, and health care-associated. 

Pneumonia is inflammation of the lung with consolidation. The cause of the inflammation is infection, which can result from a wide range of organisms. There are five classifications of pneumonia community-acquired, aspiration, hospital-acquired, ventilator-associated, and health care-associated. Patients who develop pneumonia in the outpatient setting and have not been in any health care facilities, which include wound care and hemodialysis clinics, have community-acquired pneumonia (CAP). Aspiration is of either oropharyngeal or gastrointestinal contents. Hospital-acquired pneumonia (HAP) is defined as pneumonia that occurs 48 hours or more after admission.1,2 Ventilator-associated pneumonia (VAP) requires endotracheal intubation for at least 48 to 72 hours before the onset of... 

Pneumonia owing to aspiration of oral contents is caused by a variety of anaerobes (Bacteroides spp., Fusobacterium spp., Prevotella spp., and anaerobic gram-positive cocci), as well as Streptococcus spp. M. catarrhalis and Eikenella corrodens may be involved, but much less frequently.14,15 When gastric contents are aspirated, then enteric gram-negative bacilli and Staphylococcus aureus are more commonly the pathogens.15... 

Aspiration of the oropharyngeal or gastric contents may lead to aspiration pneumonia or chemical (acid) pneumonitis. Risk factors for aspiration include... 

Presentation of Severe Community-Acquired or Aspiration Pneumonia... 

As stated in the clinical presentation of community-acquired or aspiration pneumonia. 

If a patient aspirates his or her oral contents and pneumonia develops, then anaerobes and Streptococcus spp. are the primary pathogens. Antibiotics active against these organisms include penicillin G, ampicillin/sulbactam, clindamycin, and metronidazole. 

Aspiration pneumonia Same as technical—aspiration comments Prolonged use of large-bore polyvinylchloride tube... 

Infectious complications of EN include aspiration pneumonia and infections related to delivery of contaminated EN formula. Aspiration is a complication with GI, mechanical, and infectious implications. Although GI infections owing to contamination of enteral formulas have been reported uncommonly, there is ample opportunity for these formulas to be seeded with organisms during the processes of transferring from the can to the delivery bag with ready-to-use formulas and during the process of reconstitution with powdered formulas. The so-called closed systems of delivery, wherein the formulas come from the manufacturer premixed in a delivery bag, should help to decrease the chance of formula contamination. 

Based on physical and chemical similarities between mineral oil and polyalphaolefins, oil accumulation in the lung (and subsequent lipoid pneumonia) may occur following the ingestion of polyalphaolefin hydraulic fluids due to aspiration, and that distribution of polyalphaolefins to the liver and fatty tissues may occur to some degree (see discussion for distribution of mineral oil hydraulic fluids). 

Mineral oil may be absorbed systemically and cause a foreign-body reaction in lymphoid tissue. Also, in debilitated or recumbent patients, mineral oil may be aspirated, causing lipoid pneumonia. 

Anaerobic bacteria are the most common etiologic agents in pneumonia that follows the gross aspiration of gastric or oropharyngeal contents. 

Alcoholism Aspiration pneumonia Pneumococcus, K pneumoniae, S. aureus, H influenzae, possibly mouth anaerobes Ticarcillin-clavulanate, piperacillin-tazobactam, plus aminoglycoside carba-penem,e fluoroquinolone ... 

The stomach is generally the least expensive and least labor-intensive access site however, patients who have impaired gastric emptying are at risk for aspiration and pneumonia. 

Solubility/miscibility Insoluble in water and ethanol. Soluble in ether and oils Biological considerations Aspiration may cause lipoid pneumonia Chemical compatibility/Stability considerations Flammable Uses (routes) Oral, vaginal, rectal, dermal. Suspending agent... 

Because clove cigarettes also contain tobacco, they carry all of the hazards of regular tobacco smoking (Council on Scientific Affairs 1988). Several cases of serious medical illness have been associated with clove cigarettes in the United States (Guidotti et al. 1989). These include cases of hemorrhagic pulmonary edema, pneumonia, bronchitis, and hemoptysis. Because eugenol anesthetizes the respiratory tract, it inhibits the normal gag reflex and has led to aspiration pneumonia in at least one case. Accidental overdoses in children have led to CNS depression, urinary abnormalities, and anion-gap acidosis. These cases were treated successfully with supportive measures (Lane et al. 1991). 

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