著者

藤田 次郎

出版者

特定非営利活動法人 日本口腔科学会

雑誌

日本口腔科学会雑誌

巻号頁・発行日

vol.66, no.4, pp.264-272, 2017

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Despite advances in diagnosis, antimicrobial therapy and supportive care modalities, pneumonia remains an important cause of morbidity and mortality. In recent years, changes in the healthcare system have shifted a considerable part of older patient care from hospitals to the community, and the traditional distinction between community – and hospital-acquired infections has become less clear. With this background, pneumonia occurring among outpatients in contact with the healthcare system has been termed healthcare-associated pneumonia. The impairment of airway protective reflexes, i.e., swallowing and cough reflexes, is thought to be one of the major causes of aspiration pneumonia in older people. Anaerobic bacteria are relatively frequent pathogens in pulmonary infections that are associated with aspiration and its associated complications including aspiration pneumonitis, lung abscess, necrotizing pneumonia and empyema. Treatment consists of relatively broad-spectrum antibiotics that can cover anaerobes. In cases with concurrent presence of renal impairment, single-agent therapy is recommended in this specific patient population. In addition, since sitafloxacin has wide-spectrum antibacterial activity against pathogens isolated from patients with aspiration pneumonia, sitafloxacin could be used for the treatment of healthcare-associated pneumonia. To prevent aspiration pneumonia in elderly patients, oral care is very important, and periodical inoculation of the Streptococcus pneumoniae vaccine as well as the influenza vaccine is recommended.