Antimicrobial Stewardship
An elderly patient presents with fevers and new oxygen requirement. Labs reveal a leukocytosis and chest x-ray reveals a lower right lung consolidation. You are concerned about an aspiration pneumonia and instinctively choose a regimen with anaerobic coverage, but is anaerobic coverage necessary? A recent article by Dr. Vedamurthy and others published in the Journal of Hospital Medicine attempts to answer this question.
Highlights
- Data regarding anaerobes as a major pathogen in aspiration pneumonia stems from studies in the 1970’s evaluating patients with presumed aspiration pneumonia. Many patients had complicated pneumonia with abscesses or pulmonary necrosis.
- More recent data in patients with uncomplicated aspiration pneumonia have shown aerobic gram-positive and/or gram-negative bacteria to be the predominant pathogenic organisms.
- Potential harms associated with unnecessary anerobic coverage include gut dysbiosis, higher incidences of antibiotic resistance organisms and C. difficile infections.
- Recommendations: Treat for CAP/HAP without specific anaerobic coverage unless patient have the following risk factors or findings:
- Macroaspiration with severe periodontal disease
- Putrid sputum
- Prolonged illness (>7 days)
- Lung abscess
- Empyema
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