319.4 📋 章末速記 Summary

319.4.1 🔑 一句話總結

Aspiration pneumonia = 微/巨吸入後感染；分 chemical pneumonitis (Mendelson syndrome — 酸性胃內容物 acute injury, sterile initially) 與 bacterial aspiration pneumonia (subacute, polymicrobial anaerobes + aerobes)；risk factors：altered mental status、dysphagia、GERD、NG tube、mechanical ventilation；lobes：dependent (supine = RLL + posterior RUL; right side down = RUL; left side down = LUL posterior + lingula)；treatment：amoxicillin-clavulanate (outpatient) / piperacillin-tazobactam or ampicillin-sulbactam (inpatient)；clindamycin alternative；duration 7-14 days；lung abscess = > 2 cm cavity + air-fluid level + airway communication；most from aspiration + anaerobes；secondary from septic pulmonary embolism (S. aureus, endocarditis, IVDU)、necrotizing pneumonia (Klebsiella, S. aureus, Acinetobacter)、obstruction (cancer, FB)；antibiotics 4-6 weeks；drainage usually not needed (spontaneous via airway)；prevention = SLP evaluation + thickened liquids + HOB ≥ 30° + oral hygiene + stroke care bundle Class I within 24h。

319.4.2 💊 治療精要

  • aspiration pneumonia outpatient：amoxicillin-clavulanate 875/125 BID × 7-14 d
  • aspiration pneumonia inpatient：ampicillin-sulbactam (Unasyn) or piperacillin-tazobactam (Zosyn) × 7-14 d
  • alternative (penicillin allergy)：clindamycin
  • MRSA risk (post-flu, IVDU)：add vancomycin
  • lung abscess：amox-clav / pip-tazo or clindamycin × 4-6 weeks；IV → PO transition；resolve > 80%
  • septic pulmonary embolism：vancomycin + source control (endocarditis treatment, IVDU intervention)
  • Mendelson syndrome (chemical)：supportive only；NO routine antibiotics
  • prevention：SLP evaluation + modified diet + HOB elevation + oral hygiene

319.4.3 🎯 盧醫師的考前提醒

  1. modern aspiration pneumonia 觀念：polymicrobial (anaerobes + aerobes); 不是 only anaerobes；amox-clav or pip-tazo 都 cover 兩種
  2. Mendelson syndrome (chemical pneumonitis) vs bacterial aspiration：前者 acute 急性 acid 損傷 → no routine abx；後者 subacute 24-72 h 後 → 用 antibiotics
  3. aspiration lobe distribution：supine (RLL + posterior RUL); 右側躺 (RUL); 左側躺 (LUL posterior + lingula); 站姿 (lower lobes)
  4. lung abscess 4-6 weeks 抗生素（vs CAP 5-7 d, HAP 7 d）；drainage usually not needed (spontaneous via airway)
  5. septic pulmonary embolism：S. aureus (endocarditis tricuspid, IVDU, indwelling catheters)；multiple bilateral peripheral cavities；treat as endocarditis + source control
  6. necrotizing pneumonia：Klebsiella (alcoholic, “currant jelly”)、S. aureus (post-flu)、Acinetobacter、B. cepacia；aggressive abx ± surgical resection
  7. stroke dysphagia screening Class I within 24 hours (AHA)：reduces aspiration pneumonia 30-50%
  8. PEG tube 在 dementia 不 prevent aspiration：原以為 reduces — 多研究顯示沒有；QOL 考量 + family discussion
  9. bronchoscopy in lung abscess：rule out foreign body, mass, atypical infection；usually delay 1-2 weeks of antibiotics first (avoid spillage)
  10. prevention strategies：SLP evaluation + thickened liquids + HOB ≥ 30° during/post meals + oral hygiene + swallowing exercises (CTAR, Shaker)