However, most frequently, the size of the inoculum is small, and the course of the illness more insidious. Bacterial pneumonitis often is caused by oropharyngeal flora, but gram-negative bacilli and other nosocomial pathogens must be considered in nursing home residents or the recently hospitalized. Bacterial pneumonitis in this setting may be caused by a wide variety of pathogens ranging from preexisting oropharyngeal flora to nosocomial pathogens. The clinician must consider nosocomial infection if the patient is coming from a nursing home or has been hospitalized recently. Empyema can occur in cases of inadequate antibiotic treatment.
Incidence is more common in males than in females.
To guide intravenous fluid therapy, baseline values should be obtained, especially with a history of poor PO intake or recurrent episodes of emesis. Empyema should be ruled out in the presence of pleural effusion. Consider tracheobronchial suction or tracheobronchoscopy to remove particulates or plugs. In the case of community-acquired aspiration pneumonia, empiric therapy must cover anaerobic and streptococcal species. Corticosteroids are not indicated but may be considered adjunctive therapy in coincident reactive airways or bronchoconstriction.