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Query: UMLS:C0032290 (aspiration pneumonia)
 2,291 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clindamycin and gentamicin were used in combination to treat 107 patients empirically for suspected aerobic-anaerobic sepsis. All patients were seriously ill and required initiation of treatment before results of cultures could be obtained. Infections included intraabdominal sepsis, hospital-acquired aspiration pneumonia, and soft tissue infections. Exudate cultured from 65 patients showed that the prediction of a mixed aerobic-anaerobic flora was correct in 46 patients (71%). Isolates from exudate included Escherichia coli, Bacteroides fragilis, clostridia, peptostreptococci, Proteus species, Klebsiella species, and Staphylococcus aureus. In 29 patients with bacteremia, the most frequent blood culture isolate was B. fragilis. Analysis of response to treatment showed that 92 patients were cured, five could not be evaluated adequately, and 10 failed to respond to therapy. Therapeutic failure primarily resulted from overwhelming sepsis, despite susceptibility of the pathogens to prescribed antibiotics.
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PMID:Empiric treatment with clindamycin and gentamicin of suspected sepsis due to anaerobic and aerobic bacteria. 85 96

The spectrum of pathogens and the microbiologic investigations used to obtain a diagnosis in 178 patients with severe pneumonia (88 percent requiring intermittent positive-pressure ventilation) are reviewed. Ninety-five patients had primary pneumonia, 31 had nosocomial pneumonia, 24 were immunocompromised patients, and 28 had aspiration pneumonia. While the spectrum of isolates conformed to the usual patterns for the different types of pneumonia, the incidence of Gram-positive infections (15 percent), predominantly Klebsiella pneumoniae, Staphylococcus aureus, (8 percent), and Legionella pneumophila (5 percent) in primary pneumonia was much higher than in community or general hospital-based studies, and only one case of Mycoplasma pneumoniae was identified. Gram stain of sputum or tracheal aspirate taken on intubation in primary pneumonia was reliably predictive of the causative organisms in both Gram-positive and Gram-negative infections when compared with infections proven by blood culture. Serologic studies were valuable in patients in whom no positive microbiologic diagnosis was evident; however, fiberoptic bronchoscopy contributed minimally to the microbiologic diagnosis in this group of patients. The cause of severe primary pneumonia differs from less severe disease, and this should be recognized when selecting empiric antibiotic therapy.
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PMID:Etiology and diagnosis of pneumonia requiring ICU admission. 841 24

In an open, prospective, multicenter trial the clinical efficacy of imipenem/cilastatin sodium (IPM/CS) for the treatment of 14 cases with aspiration pneumonia was investigated. The mean age was 75.4 years old. Diseases of central nervous system were present in 11 cases, cardiovascular diseases, pulmonary diseases and diabetes mellitus in 2 cases each respectively. Seven cases were community-acquired and another seven were hospital-acquired. Six cases were moderate and 8 cases were severe. Causative organisms were determined in 9 cases (64.3%), multiple causative organisms were isolated in 3 cases. Isolated organisms were Staphylococcus aureus (4), Pseudomonas aeruginosa (3), Klebsiella pneumoniae (3), Escherichia coli (1), Acinetobacter calcoaceticus (1). Detection of anaerobes was not attempted. Clinical effects of IPM/CS were excellent in 3, good in 8, fair in 2, poor in 1, the efficacy rate was thus 78.6%. P. aeruginosa was isolated from 2 out of 3 cases in which therapy with IPM/CS failed. Monotherapy with IPM/CS appears to be highly effective for cases of aspiration pneumonia, but the disease due to IPM-resistant P. aeruginosa is an exception.
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PMID:[Clinical evaluation of therapy for aspiration pneumonia with imipenem/cilastatin sodium]. 211 7

The microbiology of empyema was studied in 72 children and adolescents whose specimens yielded bacterial growth after inoculation for aerobic and anaerobic bacteria. A total of 93 organisms, 60 aerobic or facultative and 33 anaerobic, were isolated. Aerobic bacteria was isolated in 48 (67%) patients, anaerobic bacteria in 17 (24%), and mixed aerobic and anaerobic bacteria in 7 (10%). The predominant aerobic or facultative bacteria were Haemophilus influenzae (15 isolates), Streptococcus pneumoniae (13), and Staphylococcus aureus (10). The predominant anaerobes were Bacteroides sp (15 isolates, including 7 Bacteroides fragilis group and 5 Bacteroides melaninogenicus group), anaerobic cocci (9), and Fusobacterium sp (6). beta-lactamase activity was detected in at least one isolate in 20 (37%) of the 54 tested patients. These included all 8 tested S aureus and 7 B fragilis group, 3 of 10 H influenzae, 2 of 4 B melaninogenicus group, and 1 of 2 Klebsiella pneumoniae. Most cases of S pneumoniae and H influenzae were associated with pneumonia. The recovery of anaerobic bacteria was mostly associated with the concomitant diagnosis of aspiration pneumonia, lung abscess, subdiaphragmatic abscess, and abscesses of dental or oropharyngeal origin. The data highlight the importance of anaerobic bacteria in selected cases of empyema in children and adolescents.
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PMID:Microbiology of empyema in children and adolescents. 218 7

We compared intravenously administered ciprofloxacin with ceftazidime in a randomized, double-blind study. Patients received ciprofloxacin 200 mg intravenously every 12 hours or ceftazidime 2 g intravenously every eight hours, with placebo infusions to maintain blinding. Therapy with metronidazole was added for suspected or documented intra-abdominal infection. Thirty-two of the 57 ciprofloxacin-treated patients were evaluable for determination of efficacy and had 41 bacterial isolates from 34 sites. Thirty-six of the 56 ceftazidime patients were evaluable for determination of efficacy and had 41 bacterial isolates from 38 sites. Seven of 35 bacteremic patients had no identifiable primary focus. The most commonly isolated pathogens were Escherichia coli, Streptococcus pneumoniae, Staphylococcus aureus, and Klebsiella pneumoniae. Cure rates and bacteriologic eradication rates were comparable. Nine patients did not improve. Patients with treatment failures in the ciprofloxacin group included a quadriplegic patient with relapse of urinary tract infection with bacteremia (K. pneumoniae). Another patient with bacteremia (Pseudomonas aeruginosa), pneumonia (Proteus vulgaris), and urinary tract infection (P. vulgaris, Providencia sp.) died on the first treatment day. The third patient (S. aureus and Streptococcus pneumoniae pneumonia) had a new aspiration pneumonia develop on the third day; the pneumococcus also persisted. Undrained S. pneumoniae empyema caused the fourth ciprofloxacin treatment failure, and the fifth patient had a relapse of S. aureus pneumonia with bacteremia. One ceftazidime-treated patient died of pneumococcal pneumonia on the first day. Another had persistent Staphylococcus epidermidis and Listeria bacteremia despite 48 hours of treatment. Two other patients had pneumonia (S. aureus and P. aeruginosa, respectively) and completed full courses of ceftazidime therapy without improvement. Five patients had pneumococcal bacteremia; four patients were cured: one of two patients in the ciprofloxacin group and three of three patients in the ceftazidime group. Significant increases in the number of platelets (four patients with ciprofloxacin treatment, one patient with ceftazidime treatment) and declines in the number of platelets (one patient with ciprofloxacin treatment, one patient with ceftazidime treatment) were observed. Intravenously administered ciprofloxacin is comparable with ceftazidime and is a safe and effective antibiotic for the treatment of patients with serious infections, including bacteremia.
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PMID:Randomized, double-blind comparative study of intravenous ciprofloxacin versus ceftazidime in the treatment of serious infections. 268 16

Eighteen patients 2 months to 11 years of age with culture proven bacterial infections were treated with parenteral ticarcillin/clavulanic acid in a noncomparative study. Seven patients had pneumonia, two had tracheobronchitis, three had soft tissue abscess, two had periorbital cellulitis, three had urinary tract infection and one had purulent bursitis. Four of the 18 were bacteremic. Organisms treated included Staphylococcus aureus (6), Pseudomonas aeruginosa (5), Haemophilus influenzae (2), Branhamella catarrhalis (2), Escherichia coli (1), Streptococcus pneumoniae (1), Klebsiella pneumoniae (1), Streptococcus pyogenes (1) and Serratia marcescens (1). Thirteen of 15 (87%) organisms tested were beta-lactamase positive. Therapy was given intravenously in six doses per day at 310 mg/kg. Duration of treatment ranged from 5 to 28 (mean 11) days, with an average time of 4 days to clinical improvement. Seventeen patients (94%) were clinically cured. One patient with recurrent aspiration pneumonia due to mixed infection with multiple gram-negative enteric bacilli failed therapy. Adverse effects were minimal and transient. Notably, mild to moderate thrombocytosis occurred in four (22%) patients that resolved uneventfully. We conclude that ticarcillin/clavulanic acid is safe and effective therapy for serious infections in hospitalized children.
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PMID:Ticarcillin/clavulanic acid combination. Treatment of bacterial infections in hospitalized children. 280 57

Oral quinolones such as ciprofloxacin are promising agents in the treatment of serious bronchopulmonary infections due to susceptible gram-negative micro-organisms such as Haemophilus influenzae, Branhamella catarrhalis, Klebsiella pneumoniae and even Pseudomonas aeruginosa. Their moderative activity against Streptococcus pneumoniae may limit the use of these agents in the treatment of acute exacerbations of chronic bronchitis and in the empiric management of community-acquired bacterial pneumonia. Further prospectively designed studies are needed to address this issue. The ability of quinolones to effectively penetrate bronchial mucosa and to be concentrated within macrophages may afford additional advantage to these agents. They should not be used as a sole agent in the treatment of aspiration pneumonia nor anaerobic pleuropulmonary disease. Quinolones are very active in experimental models of Legionnaire's disease and deserve further clinical study. Ciprofloxacin is a promising alternative to standard parenteral drugs in the management of Pseudomonas aeruginosa infections in adults with cystic fibrosis. The potential for drug interactions with theophylline must be kept in mind for patients on both of these drugs.
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PMID:Role of fluoroquinolones in lower respiratory tract infections. 292 Apr 82

Aspiration pneumonia is characterized by a pneumonitis in a dependent segment of the lung with typical necrosis or abscess-formation in the parenchyma. Observed aspiration or predisposition to aspiration, cavitation or abscess formation, with or without empyema fluid and isolation of distinctive micro-organisms are important clues to the diagnosis. Diagnostic procedures to collect anaerobic uncontaminated secretions are transtracheal aspiration, blood cultures, pleural fluid aspiration, fibreoptic bronchoscopic protected investigations and percutaneous transthoracic aspiration. Leading pathogens in more than 90% are anaerobic bacteria, mostly species of Bacteroides, Fusobacterium, Peptococcus and Peptostreptococcus; aerobic bacteria include Staphylococcus aureus and Gram-negative bacilli, mainly Klebsiella spp. and Pseudomonas aeruginosa. Treatment depends on bacteriological results; penicillin G and clindamycin are the most useful antibiotics against anaerobes and should be administered over a long period of time (4-12 weeks), adjusted to the clinical course of the individual patient.
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PMID:Microbiological and clinical aspects of aspiration pneumonia. 329 Jan 85

Aspiration pneumonia in adults has been shown to involve anaerobes about 90% of the time. Studies of the bacteriology of aspiration pneumonia in children done in the past have either failed to exclude the oral and upper respiratory tract flora or have not utilized proper anaerobic culture techniques or both. In the present study. 74 institutionalized children with aspiration pneumonia were studied by percutaneous transtracheal aspiration. Their average age was 8 years. Fifty-two patients had pneumonitis, 12, necrotizing pneumonia, and 10, lung abscess. Only one patient (with lung abscess) had a complicating empyema. There was an average of five bacteria isolated per specimen--2.8 anaerobes and 2.2 nonanaerobes. The predominant anaerobic isolates were Gram-positive cocci, Bacteroides melaninogenicus, and fuso-bacteria; there were ten patients who yielded members of the Bacteroides fragilis group. The predominant nonanaerobes were alpha-hemolytic streptococci, Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. Thus, aspiration pneumonia in children, as in adults, commonly involves anaerobic bacteria. When aspiration occurs in a medical institution, nosocomial pathogens which are aerobic or facultative will also often be involved, in both children and adults.
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PMID:Bacteriology of aspiration pneumonia in children. 699 Mar 74

Multiple extremity gangrene developed in five patients as a complication of dopamine therapy. The clinical conditions were (1) penetrating chest trauma requiring pneumonectomy with postoperative sepsis, (2) cardiac arrest with aspiration pneumonia, (3) lymphoma with sepsis, (4) Klebsiella pneumonia, and (5) myocardial infarction. The development of acrocyanosis leading to gangrene occurred at dopamine dosages of 5.1 to 10.2 micrograms/kg/min. The alpha-adrenergic vasoconstriction effects of dopamine would not be expected from the doses employed in these patients. Thus, other factors beside pure alpha vasoconstriction are responsible for tissue necrosis after the use of dopamine. We believe that the embolic complications of disseminated intravascular coagulation and hypovolemia are serious risk factors in the development of dopamine gangrene. Peripheral vasoconstriction from dopamine, even at low doses, may set the stage for thrombotic complications of disseminated intravascular coagulation and lead to tissue damage. In laboratory models of disseminated intravascular coagulation, an alpha-adrenergic drug is required to produce peripheral ischemic tissue damage. Treatment of tissue ischemia related to dopamine depends on early recognition of acrocyanosis. Phentolamine, an alpha blocker, has been recommended for treating dopamine ischemia, either through local instillation into ischemic tissues or intravenous infusion. We recommend a high index of suspicion for, and early treatment of, underlying consumptive coagulopathy in all patients requiring dopamine.
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PMID:Dopamine gangrene. Association with disseminated intravascular coagulation. 730 16


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