Background
Microbiology
- Usually polymicrobial, including oral anaerobes
- Can also be monomicrobial, caused by Klebsiella, Staphylococcus aureus, Pseudomonas aeruginosa, Burkholderia pseudomallei (melioidosis), Pasteurella multocida, Streptococcus pyogenes, Haemophilus influenzae types b and c, Legionella species, Rhodococcus equi, Actinomyces species, and Nocardia species
Pathophysiology
- Mostly from chronic aspiration
Risk Factors
- Chronic aspiration from any etiology
- Alcohol use disorder
- Seizures, stroke, drug overdose, general anesthesia
- Dysphagia or respiratory dysfunction from ALS, Parkinson’s disease, or stroke
- Tooth extraction
Management
- Unless clearly monomicrobial, should treat broadly and include good anaerobic coverage
- Antibiotics usually for 6 to 8 weeks
- Can follow progress radiographically
- Rarely, surgical intervention
