title: Is penicillin G an adequate initial treatment for aspiration pneumonia? A prospective evaluation using a protected specimen brush and quantitative cultures.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service de Réanimation Médicale, Hôpital Louis Mourier, Colombes, France.
authors.forename: L
authors.initials: L
authors.lastname: Mier
authors.forename: D
authors.initials: D
authors.lastname: Dreyfuss
authors.forename: B
authors.initials: B
authors.lastname: Darchy
authors.forename: J J
authors.initials: JJ
authors.lastname: Lanore
authors.forename: K
authors.initials: K
authors.lastname: Djedaïni
authors.forename: P
authors.initials: P
authors.lastname: Weber
authors.forename: P
authors.initials: P
authors.lastname: Brun
authors.forename: F
authors.initials: F
authors.lastname: Coste
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001207:Asepsis / Q000295:instrumentation; D020680:Bronchoscopes; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D015897:Comorbidity; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D004066:Digestive System Diseases / Q000453:epidemiology; D004352:Drug Resistance, Microbial; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000494:pharmacology / Q000627:therapeutic use*; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D013048:Specimen Handling / Q000295:instrumentation*
chemical_list: D010400:Penicillin G