385. Prevalence of Pseudomonas in Aspiration Pneumonia
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Introduction: Pseudomonas aeruginosa causes fatal nosocomial infections each year, including aspiration pneumonia. The recommended treatment for pneumonia associated with Pseudomonas includes cephalosporins (ceftazidime and cefepime), ciprofloxacin, levofloxacin, piperacillin, or a carbapenem. In our hospital, ceftazidime has been used empirically for all pneumonias in patients either having aspiration risks or coming from a medical facility. It is vital to determine the appropriateness of the empirical usage of ceftazidime to prevent development of resistant strains.
Methods: In a retrospective study, patients were selected from Diagnosis-Related Groups for aspiration pneumonia and its risk factors. The diagnosis of aspiration pneumonia was based on clinical findings, radiographic findings, and blood and sputum cultures. In our microbiology laboratory, sputum specimens with fewer than 25 epithelial cells/low power field are accepted for culture; and Pseudomonas aeuroginosa is identified by colony morphology, oxidase test and Vitek card number 149 and 150. The selection criteria included only those patients with both risk factors and diagnostic findings suggestive of aspiration pneumonia.
Results: 78 patients were eligible. 32 patients had positive cultures: 22 for sputum and 10 for blood (8 coagulase negative staphylococci, likely contaminants; 1 klebsiella; and 1 for both MRSA and enterococci). Of the 22 positive sputum cultures only 2 (or 3% of 78) were positive for Pseudomonas aeruginosa; both were ceftazidime resistant. Both patients were aged 50-70 years and came from home: one had history of methadone addiction and hepatic encephalopathy; the other, nasopharyngeal carcinoma.
Conclusion: Our results discourage the empiric use of ceftazidime in aspiration pneumonia even in patients with aspiration risk factors. In keeping with current recommendations, empirical treatment of aspiration pneumonia should be clindamycin and ceftriaxone.
Muhammad Gill, MD1, Majid Ibrahim, MD2, Kell Julliard, MA2, Tehmina Malik, MD2, Muhammad Muzaffar, MD2, Smiti Parikh, PharmD2, Rohit Sharma, MD3, David Tompkins, MD2, Ernest Visconti, MD2 and  R. Sharma, None..
M. A. Muzaffar, None..
T. Malik, None..
M. Gill, None..
S. Parikh, None..
M. Ibrahim, None..
K. Julliard, None..
D. Tompkins, None..
E. Visconti, None., (1)Lutheran Medical Center, Rooklyn, NY, (2)Lutheran Medical Center, Brooklyn, NY, (3)Clinical Research, Lutheran Medical Center, Brooklyn, NY