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Anaerobic coverage in suspected aspiration pneumonia?

sliceofbread136

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I’ve heard varying opinions on this. Some attendings seem to advocate for clinda in every patient with possible aspiration while others tend to never use clinda except when they want more staph coverage.

the only actual evidence I’ve been able to find is with trans thoracic biopsies of lung abscesses which do seem to show anaerobes (are these even pathogens?). Data otherwise seems limited due to the need for invasive sampling and the indolent nature of these pathogens.

Is there any other data out there that someone wouldn’t mind pointing me to?
 

kb1900

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Look up the ATS 2019 guidelines. It’s in q/a format and I believe this is covered.


Generally you can always see what references these “guidelines” use to form your own opinions as well. obviously “expert panel”/survey < some kind of systematic review/meta analysis of rcts
 

sliceofbread136

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For anyone curious this is what I found the most interesting: The Role of Anaerobes in Patients With Ventilator-associated Pneumonia and Aspiration Pneumonia: A Prospective Study

Study showed similar incidence of anaerobes as previous studies I found using trans tracheal samples (16%) however most of the cases with anaerobes resolved without anaerobic coverage.

interesting fairly consistently gnr have the highest incidences in cases of aspiration, with what seem like frequent cases of mdr kleb and some pseudomonas. Seems to me this points to having a lower threshold for use of ceftazidime or cefepime in patients with suspected severe aspiration pneumonia.
 
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