319 Ch 318. Aspiration Pneumonia, Anaerobic Lung Infections, and Lung Abscess

Aspiration pneumonia = 微吸入或巨吸入後感染；分 (1) chemical pneumonitis (Mendelson syndrome) — 酸性胃內容物 inhalation；(2) bacterial aspiration pneumonia — anaerobes + GNR + S. aureus；現代研究改變傳統 anaerobe-only 認知 — 多數為 mixed anaerobic + aerobic；risk factors：altered mental status（stroke, dementia, intoxication, seizure, anesthesia）、dysphagia、GERD、NG tube、mechanical ventilation；lung abscess = 肺實質壞死性 cavity，多由 aspiration + anaerobes；bronchiectasis + empyema 為相關併發症；治療：amoxicillin-clavulanate 或 piperacillin-tazobactam (covers anaerobes)；lung abscess 4-6 weeks 抗生素；surgical drainage if refractory；aspiration prevention：thickened liquids, SLP evaluation, head-of-bed elevation, NG tube placement check, swallowing exercises；2024 stroke management bundles + dysphagia screening。