Pneumonia versus aspiration pneumonitis in nursing home residents: diagnosis and management.
OBJECTIVE
To determine the frequency of aspiration pneumonitis in nursing home residents with an initial diagnosis of pneumonia and to compare the clinical characteristics, management, and outcome of aspiration pneumonitis with those of pneumonia.


METHODS
Retrospective chart review.


METHODS
Hospital geriatric unit for nursing home residents.


METHODS
Nursing home residents admitted to the inpatient geriatric unit with suspected pneumonia between May 1999 and April 2001 (n = 195 episodes).


METHODS
Aspiration events were defined as definite (witnessed or unwitnessed) or suspected. Aspiration pneumonitis was defined as symptoms/signs of lower respiratory tract infection plus a history of an aspiration event plus a lower lobe infiltrate on chest radiograph. Pneumonia was defined as symptoms/signs of lower respiratory tract infection plus an infiltrate on chest radiograph plus no history of an aspiration event.


RESULTS
The 195 episodes were stratified into three clinical groups: aspiration pneumonitis (n = 86; aspiration history/infiltrate), pneumonia (n = 43; no aspiration history/infiltrate), and an aspiration event (n = 66; aspiration history/no infiltrate). In general, symptoms, signs, and laboratory tests were not useful in distinguishing between the three groups. Survivors with aspiration pneumonitis (13/75 (17%)) or with an aspiration event (20/60 (33%)) were significantly more likely not to be treated with an antibiotic or to be treated for 1 day or less than those with pneumonia (0/41; P <.001). Excluding those not treated, significantly more patients with pneumonia (33/40 (83%)) were discharged on antibiotic treatment than those with aspiration pneumonitis (35/70 (50%)) or an aspiration event (21/51 (41%); P <.001). There was no significant difference in hospital mortality between the three clinical groups.


CONCLUSIONS
The findings of this study have implications for the diagnosis and management of suspected pneumonia in nursing home residents but require prospective validation.
Mylotte
Joseph M
JM
Department of Medicine, Division of Infectious Diseases, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, USA. mylotte@buffalo.edu
Goodnough
Susan
S
Naughton
Bruce J
BJ
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006757:Hospital Units; D006801:Humans; D007902:Length of Stay; D008297:Male; D009735:Nursing Homes; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D011015:Pneumonia, Aspiration / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone