Mary Campbell Dept. OF COMMUNICATION SCIENCES & DISORDERS - PowerPoint Presentation

1. Mary CampbellDept. OF COMMUNICATION SCIENCES & DISORDERSWayne state universityPneumonia Isn’t Always the Result of Aspiration

2. Pneumonia Isn’t Always the Result of Aspiration What is Pneumonia? Identifying Varieties of Pneumonia. Determining Etiology. The Elderly, a Vulnerable Population. Identifying Aspiration Pneumonia. Conclusion

3. What is Pneumonia? According to the Mayo Clinic it is:Inflammation of the lungs caused by infection.Can be caused by bacteria, viruses, fungi or parasites.Can arise as a complication of another condition, such as the flu.Can range in seriousness from mild to life-threatening.

4. Identifying Varieties of Pneumonia Viral (Community Acquired) PneumoniaMost Common pneumonia in children under 51/3 of all cases of pneumoniaBacterial Community Acquired Pneumonia (CAP).Streptococcus pneumoniae is causative in 2/3 of all CAP.Most common variety of pneumonia in older children and adults.The most frequent cause of pneumonia in nursing home patients (Lieberman et al., 1997).

5. Identifying Varieties of Pneumonia Pneumonias are typically named based on where the infection was acquired, not the pathogen.Community Acquired Pneumonia (CAP)Hospital Based PneumoniaNursing Home Acquired Pneumonia (NHAP) Etiology is often assumed based on setting.Community Acquired Pneumonia = airborne pathogenNursing Home Acquired Pneumonia = aspiration

6. Identifying Varieties of PneumoniaAspiration pneumonia:Right lower lobe is implicated.Is assumed if the patient has increased risk factors for aspiration (Tada et al., 2012)Dysphagia due to neurological disease Gastroesophageal reflux disease.Dysphagia due to decreased oropharyngeal and gastroesophageal motility.

7. Determining Etiology of PneumoniaTrue etiology is difficult to determine.Even when actively investigated, the definitive cause only found in 52-83% of the cases. (File, 2003)Typical pulmonary pathogens are often difficult to culture.Pneumonia can arise from more than one pathogen at the same time. Treatment begins immediately without diagnosing etiology.Unethical to withhold treatment.Knowing etiology not necessary to begin treatment.Most people are treated and released.Therapy started within 4 hours yields better outcomes.

8. The Elderly, More Prone to PneumoniaNormally healthy, independent elderly individuals have the same susceptibility as the general populace.All people are more vulnerable to infection when they have a compromised immune system.Many elderly individuals suffer from comorbid conditions that weaken their immune system.Chronic Obstructive Pulmonary DiseaseNeurologic disease.Renal insufficiencyDiabetesMalignancyStrokeCardiac conditions G.E.R.D.

9. The Elderly, More Prone to PneumoniaAspiration pneumonia has been reported to be the second most frequent principle diagnosis among hospitalized Medicare patients (El-Solh et al., 2003, Langmore et al., 2002).Also, the second most common cause of infection in nursing home residents.

10. Identifying Aspiration PneumoniaIncreased risk of aspiration pneumonia in hospitals and nursing homes because:Altered level of consciousness.The use of naso-gastric tubes and PEG tubes.The orophayngeal cavities of those not orally fed remain undisturbed for long periods of time and allow large colonies of bacteria to flourish.Dysphagia resulting from illness or brain injury.Natural bacteria that would compete for the environment are eliminated with antibiotics, leaving the oral-pharyngeal cavity vulnerable to “pathogenic bacterial colonization” (Langdon, 2009).

11. Identifying Aspiration PneumoniaIdentifying bacteria responsible (El-Solh et al., 2003):Gram-negative enteric bacilli (49%)Anaerobic bacteria (16%)Staph aureaus (12%)Anaerobes were found in combination with enteric gram negative bacilliThe Bates Study (Bates et al., 1992)Patients with community acquired and hospital acquired pneumonia were included in the studyDetailed study with rigorous inclusion criteria.Intensive testing done to identify responsible pathogensExact etiology could only be determined in 51% of cases.A significant presence of gram -negative bacilli was found.

12. ConclusionAspiration pneumonia is not the most common cause of pneumonia, but is more common with certain populations (the elderly, those with compromised immune systems, nursing home residents). Because of limited diagnostic and etiologic information, aspiration pneumonia is underestimated in community acquired pneumonia and overestimated in nursing home acquired pneumonia.Bates study with rigorous testing methods found a large amount of gram-negative and anaerobic bacterial pathogens. This would implicate aspiration across populations, including community acquired pneumonia.Younger people without compromised immune systems may aspirate but are better able to combat infection.

13. ReferencesBates, J. H., Campbell, G. D., Barron, A. L., McCracken, G. A., Morgan, P. N., Moses, E. B., & Davis, C. M. (1992, April). Microbial etiology of acute pneumonia in hospitalized patients. CHEST, 101(4), 1005-1012. doi:10.1378/chest101.41005El-Solh, A. A., Pietrantoni, C., Bhat, A., Aquilina, A. T., Okada, M., Grover, V., & Gifford, N. (2003, April 10). Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med, 167(12), 1650-1654.Fein, A. M. (1999, April). Pneumonia in the elderly: Overview of diagnostic and therapeutic approaches [Electronic version]. Clinical Infectious Diseases, 28(4), 726-729. doi:10.1086/515218File, T. M. (2003, December 13). Community-acquired pneumonia. The Lancet, 362(9400), 1991-2001. Retrieved July 9, 2012Klapdor, B., Ewig, S., Schaberg, T., Rohde, G., Pletz, M. W., Schutte, H., & Weite, T. (2012, July). Presentation, etiology and outcome of pneumonia in younger nursing home residents. Journal of Infection, 65(1), 32-38. doi:10.1016/j.jinf.2012.02.003Langdon, P. C., Lee, A. H., & Binns, C. W. (2009, February). High incidence of respiratory infections in 'nil by mouth' tube-fed acute ischemic stroke patients. Neuroepidemiology, 32(2), 107-113. doi: 10.1159/000177036Langmore, S. E., Skarupski, K. A., Park, P. S., & Fries, B. E. (2002, December). Predictors of aspiration pneumonia in nursing home residents. Dysphagia, 17(4), 298-307. doi:10.1007/s00455-002-0072-1

14. ReferencesLieberman, D., Lieberman, D., Schlaeffer, F., & Porath, A. (1997). Community-acquired pneumonia in old age: a prospective study of 91 patients admitted from home. Age and Aging, 26(2), 69-75. doi: 10.1093/ageing/26.2.69Marrie, T. J., Poulin-Costello, M., Beecraft, M. D., & Herman-Gnjidic, Z. (2005, January). Etiology of community-acquired pneumonia treated in an ambulatory setting [Electronic version]. Respiratory Medicine, 99(1), 60-65.Mylotte , J.M., (2002). Nursing Home-Acquired Pneumonia. Clinical Infectious Diseases, 35(10),1205-1211. doi: 10.1086/344281.Pneumonia. (n.d.). In Mayo Clinic. Retrieved May 10, 2011, from www.mayoclinic.com.Tada, A., & Miura, H. (2012, July). Prevention of aspiration pneumonia (AP) with oral care [Electronic version]. Archives of Gerontology and Geriatrics, 55(1), 16-21. doi:10.1016/j.archger.2011.06.029Types of Pneumonia. (2011, March 1). In National Heart Lung and Blood Institute. Retrieved July 20, 2012, from http://www.nhlbi.nih.gov Understanding Pneumonia. (n.d.). In American Lung Association. Retrieved July 20, 2012, from http://www.lung.org