Neumonia aspirativa

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edn. Washington, DC: American Society for Microbiology; 2003. p. 585e608. Isenberg HD. Clinical microbiology procedures handbook. 2nd edn. Washington, DC: American Society for Microbiology; 2004. pp. 13.10.1e13.10.12. Weisburg WG, Barns SM, Pelletier DA, Lane DL. 16S-ribosomal DNA amplification for phylogenetic study. J Bacteriol 1991; 173:697e703. Cheron M, Abachin E,Guerot E, el-Bez M, Simonet M. Investigation of hospital-acquired infections due to Alcaligenes denitrificans subsp. xylosoxidans by DNA restriction fragment length polymorphism. J Clin Microbiol 1994;32:1023e 1026. Dunne Jr WM, Maisch S. Epidemiological investigation of infections due to Alcaligenes species in children and patients with cystic fibrosis: use of repetitive-element-sequence polymerasechain reaction. Clin Infect Dis 1995; 20:836e841. Woods CR, Versalovic J, Koeuth T, Lupski JR. Analysis of relationships among isolates of Citrobacter diversus by using DNA fingerprints generated by repetitive sequence-based primers in the polymerase chain reaction. J Clin Microbiol 1992;30:2921e2929. Hoffman P, Arnow P, Goldman D, Parrott P, Stamm W, Mcgowan J. False positive blood cultures.Association with nonsterile collection tubes. J Am Med Assoc 1976;236: 2073e2075.

399 Bacteriology of aspiration pneumonia due to delayed triggering of the swallowing reflex in elderly patients

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Madam, Aspiration is important as a frequent mechanism for hospital-acquired pneumonia.1 However, the aetiological agents of aspiration pneumonia have not been well characterised because of thedifficulty in diagnosis. Recently, aspiration pneumonia was defined by the Japanese Study Group on Aspiration Pulmonary Disease as pneumonia in a patient with predisposition to aspiration due to dysphagia or swallowing disorders.2 Here, the swallowing dysfunction was assessed by evaluating the latent time of the swallowing reflex, induced by an injection of 1 mL solution into the pharynx.3 In this study,the aetiology of aspiration pneumonia diagnosed by assessment of swallowing reflex was investigated. Patients were prospectively and consecutively recruited from those referred and admitted to the Geriatric Unit, in Tohoku University Hospital for treatment of pneumonia from April 2003 to May 2008. Pneumonia was diagnosed by the presence of pulmonary infiltration on chest radiograph and computedtomography and according to systemic inflammation determined according to white blood cell (WBC) count and C-reactive protein (CRP). The criteria for pneumonia were established according to the pneumonia guidelines of the Japan Respiratory Society.4 Patients with severe immunosuppression (solid organ transplantation, steroid therapy of !20 mg/day for >2 weeks, known human immunodeficiency virus, oracquired immune deficiency syndrome-defining criteria) or who had received antibiotics within 6 weeks were excluded. In our unit, all elderly patients (>75 years old) with pneumonia had fasted at time of admission. When they had recovered after treatment such as intravenous antibiotics, consideration was given to letting them restart eating. Their swallowing reflex was estimated before making the decisionto start eating. The swallowing reflex was induced by a bolus injection of 1 mL distilled water into the pharynx through a nasal catheter (8F). The subjects were unaware of the actual injection. Swallowing was identified by submental electromyographic (EMG) activity and visual observation of characteristic laryngeal movement. EMG activity was recorded from surface electrodes on the chin. Theswallowing reflex was evaluated by the latency of response, timed from the injection to the onset of swallowing.3 If the latency of

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M. Almuzaraa,* M. Matteob R. Cittadinic E. Bertonac R. Armitanob M. Catalanob M. del Castilloc C. Vaya,c a ´ Laboratorio de Bacteriologıa, Instituto de ´ ´ ´ Fisiopatologıa y Bioquımica Clınica, Facultad de ´ Farmacia y Bioquımica, Universidad...