A 65-year-old man is admitted to ICU following aspiration pneumonitis. He aspirated vomitus during a seizure. CXR shows right lower lobe consolidation...

Question

A 65-year-old man is admitted to ICU following aspiration pneumonitis. He aspirated vomitus during a seizure. CXR shows right lower lobe consolidation. ABG on FiO2 0.4: pH 7.35, PaO2 8.5 kPa, PaCO2 5.0 kPa. He is febrile (38.2°C) 6 hours after the event. Should empirical antibiotics be started?

Accepted Answer

No - aspiration pneumonitis is a chemical inflammation that does not initially require antibiotics; monitor clinically and start antibiotics only if bacterial pneumonia develops (persistent fever >48 hours, worsening infiltrates, rising inflammatory markers, purulent sputum)

Answer

Yes - start broad-spectrum antibiotics immediately for all aspiration events

Answer

Yes - start antifungal therapy

Answer

No - aspiration never leads to pneumonia

Answer

Yes - start metronidazole alone for anaerobic cover

uk-fficm MCQ (SBA): Aspiration Pneumonitis

A 65-year-old man is admitted to ICU following aspiration pneumonitis. He aspirated vomitus during a seizure. CXR shows right lower lobe consolidation. ABG on FiO2 0.4: pH 7.35, PaO2 8.5 kPa, PaCO2 5.0 kPa. He is febrile (38.2°C) 6 hours after the event. Should empirical antibiotics be started?