Northwell Health, Manhasset, New York.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
J Hosp Med. 2019 Jul 1;14(7):429-435. doi: 10.12788/jhm.3154. Epub 2019 Feb 20.
Aspiration pneumonia refers to an infection of the lung parenchyma in an individual that has inhaled a bolus of endogenous flora that overwhelms the natural defenses of the respiratory system. While there are not universally agreed upon criteria, the diagnosis can be made in patients with the appropriate risk factors and clinical scenario, in addition to a radiographic or an ultrasonographic image of pneumonia in the typical dependent lung segment. Treatment options for aspiration pneumonia vary based on the site of acquisition (community-acquired aspiration pneumonia [CAAP] versus healthcare-associated aspiration pneumonia [HCAAP]), the risk for multidrug-resistant (MDR) organisms, and severity of illness. Hospitalized CAAP patients without severe illness and with no risk for MDR organisms or Pseudomonas aeruginosa (PA) can be treated with standard inpatient community-acquired pneumonia therapy covering anaerobes. Patients with CAAP and either of the following-risk factors for MDR pathogens, septic shock, need for an intensive care unit (ICU) admission, or mechanical ventilation-can be considered for broader coverage against anaerobes, methicillin-resistant Staphylococcus aureus (MRSA), and PA. Severe aspiration pneumonia that originates in a long-term care facility or HCAAP with one or more risk factors for MDR organisms should be considered for similar treatment. HCAAP with one or more risk factors for MDR organisms or PA, plus septic shock, need for ICU admission or mechanical ventilation should receive double coverage for PA in addition to coverage for MRSA and anaerobes. Multiple gaps in current understanding and management of aspiration pneumonia require future research, with a particular focus on antibiotic stewardship.
吸入性肺炎是指个体吸入大量内源性菌群，使呼吸系统的天然防御机制不堪重负，从而导致肺部实质感染。虽然没有普遍认可的标准，但在具有适当危险因素和临床情况的患者中，可以做出诊断，此外，在典型的依赖肺段中还存在肺炎的放射学或超声图像。吸入性肺炎的治疗选择因获得部位（社区获得性吸入性肺炎 [CAAP] 与医疗保健相关性吸入性肺炎 [HCAAP]）、耐多药（MDR）病原体的风险以及疾病严重程度而异。无严重疾病且无 MDR 病原体或铜绿假单胞菌（PA）风险的住院 CAAP 患者可以使用标准的住院社区获得性肺炎治疗方案治疗，覆盖厌氧菌。对于 CAAP 患者，且具有以下 MDR 病原体危险因素之一、感染性休克、需要入住重症监护病房（ICU）或机械通气的患者，可以考虑针对厌氧菌、耐甲氧西林金黄色葡萄球菌（MRSA）和 PA 进行更广泛的覆盖。起源于长期护理机构或 HCAAP 且具有一个或多个 MDR 病原体危险因素的严重吸入性肺炎应考虑类似的治疗方法。对于 HCAAP 且具有一个或多个 MDR 病原体或 PA 的危险因素，加上感染性休克、需要 ICU 入院或机械通气的患者，除了覆盖 MRSA 和厌氧菌外，还应针对 PA 进行双重覆盖。目前对吸入性肺炎的认识和管理存在多个空白，需要进一步研究，特别关注抗生素管理。
