Metronidazole plus penicillin is a reasonable alternative. For patients with nosocomial aspiration pneumonia, the greatest concern is for gram-negative bacilli and S. aureus as components of mixed infections. These organisms are readily detected with cultures of expectorated sputum, and in vitro sensitivity tests are used to assist in antibiotic selection. An alternative for patients allergic to penicillin is aztreonam plus clindamycin. Particulate matter can lodge in the lower airways.
Symptoms depend on the caliber of both object and airway.
Obstruction high in the trachea may produce acute apnea, often with aphonia and rapid death. Obstruction of more distal airways results in an irritating chronic cough and sometimes in recurrent infections distal to the obstruction. Another clue to this diagnosis is recurrent parenchymal infections in the same segment of lung. Therapy consists of extracting the object, usually by bronchoscopy. All rights reserved.