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Aging and Disease    2015, Vol. 6 Issue (1) : 27-37     DOI: 10.14336/AD.2014.0127
Healthcare-associated Pneumonia and Aspiration Pneumonia
Kosaku Komiya1, 2, Hiroshi Ishii3, Jun-ichi Kadota1
1Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Japan
2Clinical Research Center of Respiratory Medicine, Tenshindo Hetsugi Hospital, Oita, Japan
3Department of Respiratory Medicine, Fukuoka University Hospital, Jonan-ku, Fukuoka, Japan
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Healthcare-associated pneumonia (HCAP) is a new concept of pneumonia proposed by the American Thoracic Society/Infectious Diseases Society of America in 2005. This category is located between community-acquired pneumonia and hospital-acquired pneumonia with respect to the characteristics of the causative pathogens and mortality, and primarily targets elderly patients in healthcare facilities. Aspiration among such patients is recognized to be a primary mechanism for the development of pneumonia, particularly since the HCAP guidelines were published. However, it is difficult to manage patients with aspiration pneumonia because the definition of the condition is unclear, and the treatment is associated with ethical aspects. This review focused on the definition, prevalence and role of aspiration pneumonia as a prognostic factor in published studies of HCAP and attempted to identify problems associated with the concept of aspiration pneumonia.

Keywords healthcare-associated pneumonia      aspiration pneumonia      elderly      diagnosis     
Corresponding Authors: Kosaku Komiya   
Online First Date: 23 November 2014    Issue Date: 02 February 2015
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Kosaku Komiya,Hiroshi Ishii,Jun-ichi Kadota. Healthcare-associated Pneumonia and Aspiration Pneumonia[J]. Aging and Disease, 2015, 6(1): 27-37.
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Figure 1.  Risk factors associated with aspiration pneumonia.

Abbreviations: CNS= central nervous system

Figure 2.  Diagnostic procedures and types of intervention for dysphagia and aspiration pneumonia.
StudyCountryDesignPatientsDefinition of aspiration pneumonia or risk factors for aspiration pneumonia
Carratalà J, et al. 200748SpainprospectiveCAP/HCAPPatients with risk factors such as compromised consciousness, altered gag reflex, dysphagia, severe periodontal disease, putrid sputum and radiographic evidence of involvement of a dependent pulmonary segment or necrotizing pneumonia.
Garcia-Vidal C, et al. 201123SpainprospectiveCAP/HCAPSame as Carratalà J, et al. 2007.
Simonetti A, et al. 201222SpainprospectiveCAP/HCAPSame as Garcia-Vidal C, et al. 2011.
Giannella M, et al. 201221SpainprospectiveCAP/HCAP/HAPAltered consciousness, altered gag reflex, dysphagia, severe periodontal disease or putrid sputum.
Falcone M, et al. 201210ItalyprospectiveHCAPPatients with risk factors such as compromised consciousness, altered gag reflex, dysphagia, severe periodontal disease, putrid sputum or necrotizing pneumonia in absence of positive respiratory specimen cultures.
Fukuyama H, et al. 201320JapanprospectiveCAP/NHCAPPatients with apparent aspiration, a condition in which aspiration is strongly expected or the existence of an abnormal swallowing function or dysphagia. Suspected patients were assessed using water swallowing tests or VE for the purpose of evaluating the swallowing function.
Shindo Y, et al. 200949JapanretrospectiveCAP/HCAPProbable aspiration was defined as any witnessed aspiration before hospital admission or aspiration confirmed by fluid-drinking test on hospital admission.
Miyashita N, et al. 201230JapanretrospectiveCAP/NHCAPPneumonia in a patient with a predisposition to aspiration because of dysphagia or a swallowing disorder. The swallowing function was assessed using the water-swallowing test, repetitive saliva-swallowing test, simple swallowing provocation test and VF. When the swallowing function was not assessed using these examinations, the presence of overt symptoms of dysphagia or a medical history of aspiration was determined to a swallowing disorder in the patient.
Ishida T, et al. 201227JapanretrospectiveCAP/NHCAPTrained nurses checked the following factors three times: a past history of aspiration, the occurrence of a choking sensation with a wet cough during meals and the presence of massive fur on the tongue. If at least one factor was identified, the patient was judged to have a risk of aspiration and the swallowing function was assessed using the water swallowing test, repetitive saliva swallowing test, VE and VF.
Miyashita N, et al. 201326JapanretrospectiveNHCAPSame as Miyashita N, et al. 2012.
Oshitani Y, et al. 201325JapanretrospectiveCAP/NHCAPInvolvement of aspiration was defined as dysphagia or aspiration confirmed or strongly suspected.
Komiya K, et al. 20138JapanretrospectiveCAP/HCAPPatients with both risk factors for aspiration and evidence of gravity-dependent opacity on chest CT.
Nakagawa N, et al. 201324JapanretrospectiveCAP/NHCAPAspiration was recorded when witnessed by a patient’s family member or care staff member before the onset of pneumonia and confirmed by a water swallowing test or swallowing test using a laryngoscope.
Table 1.  Definition of aspiration pneumonia among studies of healthcare-associated pneumonia
StudyRatio in CAP/(N)HCAPRatio in CAPRatio in (N)HCAPCrude mortality or adjusted OR or HR
Carratalà J, et al. 20074844/727 (6.1%)18/601 (18%)26/126 (20.6%)n.a.
Garcia-Vidal C, et al. 201123162/2153 (7.5%)91/1668 (5.5%)71/485 (14.6%)n.a.
Simonetti A, et al. 201222123/1593 (7.7%)68/1274 (5.3%)55/319 (17.2%)no significance?
Giannella M, et al. 201221262/898 (29.2%)108/591 (18.3%)154/307 (50.2%)OR 0.87 (0.48–1.57) p=0.66 for in-hospital mortality
Falcone M, et al. 201210n.a.n.a.55/217 (25.3%)OR 4.94 (1.71–14.27) as in-hospital mortality with significance
Fukuyama H, et al. 201320129/306 (42.2%)7/114 (6.1%)122/192 (63.5%)14.8% vs 4.3% 30 day-mortality
Shindo Y, et al. 200949124/371 (33.4%)42/230 (18.3%)82/141 (58.2%)n.a.
Miyashita N, et al. 201230492/1385 (35.5%)122/786 (15.5%)370/599 (61.8%)no significance?
Ishida T, et al. 201227376/893 (42.1%)96/451 (21.3%)280/442 (63.3%)n.a.
Miyashita N, et al. 201326n.a.n.a.370/599 (61%)n.a.
Oshitani Y, et al. 201325382/718 (53.2%)24/241 (10%)358/477 (75.1%)no significance in NHCAP
Komiya K, et al. 20138116/637 (18.2%)n.a.n.a.HR 5.690 (2.306–14.040) <0.001 at 30 days
Nakagawa N, et al. 201324484/960 (50.4%)46/373 (12.3%)438/587 (74.6%)72/484 (14.9%) vs 28/476 (5.9%) during hospitalization
Table 2.  Prevalence and role of aspiration pneumonia as a prognostic factor among studies defining aspiration pneumonia in patients with CAP and (N)HCAP
[1] American Thoracic SocietyInfectious Diseases Society of America2005). Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 171:388-416
[2] Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ(2005). Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest, 128:3854-3862
[3] Seymann GB, Di Francesco L, Sharpe B, Rohde J, Fedullo P(2009). The HCAP gap: differences between self-reported practice patterns and published guidelines for health care-associated pneumonia. Clin Infect Dis, 49:1868-1874
[4] Grenier C, Pepin J, Nault V, Howson J, Fournier X(2011). Impact of guideline-consistent therapy on outcome of patients with healthcare-associated and community-acquired pneumonia. J Antimicrob Chemother, 66:1617-1624
[5] Attridge RT, Frei CR(2011). Health care-associated pneumonia: an evidence-based review. Am J Med, 124:689-697
[6] Chalmers JD, Taylor JK, Singanayagam A, Fleming GB, Akram AR(2011). Epidemiology, antibiotic therapy, and clinical outcomes in health care-associated pneumonia: a UK cohort study. Clin Infect Dis, 53:107-113
[7] Ewig S, Welte T, Chastre J, Torres A(2010). Rethinking the concepts of community-acquired and health-care-associated pneumonia. Lancet Infect Dis, 10:279-287
[8] Komiya K, Ishii H, Umeki K, Mizunoe S, Okada F(2013). Impact of aspiration pneumonia in patients with community-acquired pneumonia and healthcare-associated pneumonia: A multicenter retrospective cohort study. Respirology, 18:514-521
[9] Polverino E, Cilloniz C, Dambrava P, Gabarrus A, Ferrer M(2013). Systemic corticosteroids for community-acquired pneumonia: reasons for use and lack of benefit on outcome. Respirology, 18:263-271
[10] Falcone M, Corrao S, Licata G, Serra P, Venditti M(2012). Clinical impact of broad-spectrum empirical antibiotic therapy in patients with healthcare-associated pneumonia: a multicenter interventional study. Intern Emerg Med, 7:523-531
[11] Teramoto S, Kawashima M, Komiya K, Shoji S(2009). Health-care-associated pneumonia is primarily due to aspiration pneumonia. Chest, 136:1702-1703
[12] Marik PE(2001). Aspiration pneumonitis and aspiration pneumonia. N Engl J Med, 344:665-671
[13] Marik PE, Kaplan D(2003). Aspiration pneumonia and dysphagia in the elderly. Chest, 124:328-336
[14] Spickard A3rd, Hirschmann JV(1994). Exogenous lipoid pneumonia. Arch Intern Med, 154:686-692
[15] Dikensoy O, Usalan C, Filiz A(2002). Foreign body aspiration: clinical utility of flexible bronchoscopy. Postgrad Med J, 78:399-403
[16] Zissin R, Shapiro-Feinberg M, Rozenman J, Apter S, Smorjik J(2001). CT findings of the chest in adults with aspirated foreign bodies. Eur Radiol, 11:606-611
[17] El-Solh AA, Pietrantoni C, Bhat A, Aquilina AT, Okada M(2003). Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med, 167:1650-1654
[18] Fernandez-Sabe N, Carratala J, Roson B, Dorca J, Verdaguer R(2003). Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine (Baltimore)82:159-169
[19] Vergis EN, Brennen C, Wagener M, Muder RR(2001). Pneumonia in long-term care: a prospective case-control study of risk factors and impact on survival. Arch Intern Med, 161:2378-2381
[20] Yamaya M, Yanai M, Ohrui T, Arai H, Sasaki H(2001). Interventions to prevent pneumonia among older adults. J Am Geriatr Soc, 49:85-90
[21] Ohrui T(2005). Preventive strategies for aspiration pneumonia in elderly disabled persons. Tohoku J Exp Med, 207:3-12
[22] Sasaki H, Sekizawa K, Yanai M, Arai H, Yamaya M(1997). New strategies for aspiration pneumonia. Intern Med, 36:851-855
[23] Fukuyama H, Yamashiro S, Tamaki H, Kishaba T(2013). A prospective comparison of nursing- and healthcare-associated pneumonia (NHCAP) with community-acquired pneumonia (CAP)J Infect Chemother, 19:719-726
[24] Giannella M, Pinilla B, Capdevila JA, Martinez Alarcon J(2012). Pneumonia treated in the internal medicine department: focus on healthcare-associated pneumonia. Clin Microbiol Infect, 18:786-794
[25] Simonetti A, Viasus D, Garcia-Vidal C, Adamuz J, Roset A(2012). Timing of antibiotic administration and outcomes of hospitalized patients with community-acquired and healthcare-associated pneumonia. Clin Microbiol Infect, 18:1149-1155
[26] Garcia-Vidal C, Viasus D, Roset A, Adamuz J, Verdaguer R(2011). Low incidence of multidrug-resistant organisms in patients with healthcare-associated pneumonia requiring hospitalization. Clin Microbiol Infect, 17:1659-1665
[27] Nakagawa N, Saito Y, Sasaki M, Tsuda Y, Mochizuki H(2013). Comparison of clinical profile in elderly patients with nursing and healthcare-associated pneumonia, and those with community-acquired pneumonia. Geriatr Gerontol Intin press
[28] Oshitani Y, Nagai H, Matsui H, Aoshima M(2013). Reevaluation of the Japanese guideline for healthcare-associated pneumonia in a medium-sized community hospital in Japan. J Infect Chemother, 19:579-587
[29] Miyashita N, Akaike H, Teranishi H, Kawai Y, Ouchi K(2013). Evaluation of serological tests for diagnosis of Chlamydophila pneumoniae pneumonia in patients with nursing and healthcare-associated pneumonia. J Infect Chemother, 19:249-255
[30] Ishida T, Tachibana H, Ito A, Yoshioka H, Arita M(2012). Clinical characteristics of nursing and healthcare-associated pneumonia: a Japanese variant of healthcare-associated pneumonia. Intern Med, 51:2537-2544
[31] Webb BJ, Dangerfield BS, Pasha JS, Agrwal N, Vikram HR(2012). Guideline-concordant antibiotic therapy and clinical outcomes in healthcare-associated pneumonia. Respir Med, 106:1606-1612
[32] Kaku N, Yanagihara K, Morinaga Y, Izumikawa K, Nagashima S(2013). The definition of healthcare-associated pneumonia (HCAP) is insufficient for the medical environment in Japan: a comparison of HCAP and nursing and healthcare-associated pneumonia (NHCAP)J Infect Chemother, 19:70-76
[33] Miyashita N, Kawai Y, Akaike H, Ouchi K, Hayashi T(2012). Clinical features and the role of atypical pathogens in nursing and healthcare-associated pneumonia (NHCAP): differences between a teaching university hospital and a community hospital. Intern Med, 51:585-594
[34] Madaras-Kelly KJ, Remington RE, Fan VS, Sloan KL(2012). Predicting antibiotic resistance to community-acquired pneumonia antibiotics in culture-positive patients with healthcare-associated pneumonia. J Hosp Med, 7:195-202
[35] Hsu JL, Siroka AM, Smith MW, Holodniy M, Meduri GU(2011). One-year outcomes of community-acquired and healthcare-associated pneumonia in the Veterans Affairs Healthcare System. Int J Infect Dis, 15:e382-387
[36] Madaras-Kelly KJ, Remington RE, Sloan KL, Fan VS(2012). Guideline-based antibiotics and mortality in healthcare-associated pneumonia. J Gen Intern Med, 27:845-852
[37] Dobler CC, Waterer G(2013). Healthcare-associated pneumonia: a US disease or relevant to the Asia Pacific, too?. Respirology, 18:923-932
[38] Falcone M, Blasi F, Menichetti F, Pea F, Violi F(2012). Pneumonia in frail older patients: an up to date. Intern Emerg Med, 7:415-424
[39] Labelle A, Kollef MH(2012). Healthcare-associated pneumonia: approach to management. Clin Chest Med, 32:507-515
[40] Falcone M, Venditti M, Shindo Y, Kollef MH(2011). Healthcare-associated pneumonia: diagnostic criteria and distinction from community-acquired pneumonia. Int J Infect Dis, 15:e545-550
[41] Polverino E, Torres A(2009). Current perspective of the HCAP problem: is it CAP or is it HAP?. Semin Respir Crit Care Med, 30:239-248
[42] Morrow LE(2009). Prevention strategies for healthcare-associated pneumonia. Semin Respir Crit Care Med, 30:86-91
[43] Restrepo MI, Anzueto A(2009). The role of gram-negative bacteria in healthcare-associated pneumonia. Semin Respir Crit Care Med, 30:61-66
[44] Polverino E, Torres A(2009). Diagnostic strategies for healthcare-associated pneumonia. Semin Respir Crit Care Med, 30:36-45
[45] Poch DS, Ost DE(2009). What are the important risk factors for healthcare-associated pneumonia?. Semin Respir Crit Care Med, 30:26-35
[46] Carratala J, Garcia-Vidal C(2008). What is healthcare-associated pneumonia and how is it managed?. Curr Opin Infect Dis, 21:168-173
[47] Chroneou A, Zias N, Beamis JFJr, Craven DE(2007). Healthcare-associated pneumonia: principles and emerging concepts on management. Expert Opin Pharmacother, 8:3117-3131
[48] Fujitani S, Yu VL(2006). A new category--healthcare-associated pneumonia: a good idea, but problems with its execution. Eur J Clin Microbiol Infect Dis, 25:627-631
[49] Mylotte JM(2006). Nursing home-acquired pneumonia: update on treatment options. Drugs Aging, 23:377-390
[50] Craven DE(2006). What is healthcare-associated pneumonia, and how should it be treated?. Curr Opin Infect Dis, 19:153-160
[51] Carratala J, Mykietiuk A, Fernandez-Sabe N, Suarez C, Dorca J(2007). Health care-associated pneumonia requiring hospital admission: epidemiology, antibiotic therapy, and clinical outcomes. Arch Intern Med, 167:1393-1399
[52] Shindo Y, Sato S, Maruyama E, Ohashi T, Ogawa M(2009). Health-care-associated pneumonia among hospitalized patients in a Japanese community hospital. Chest, 135:633-640
[53] Kohno S, Imamura Y, Shindo Y, Seki M, Ishida T(2013). Clinical practice guidelines for nursing- and healthcare-associated pneumonia (NHCAP) [complete translation]. Respir Investig, 51:103-126
[54] RS Fraser NLM, Colman Neil, Pare PD(1999). Features of Pulmonary Infection. Fraser and Pare’s Diagnosis of Diseases of the ChestW.B. SaundersII
[55] Gleeson K, Eggli DF, Maxwell SL(1997). Quantitative aspiration during sleep in normal subjects. Chest, 111:1266-1272
[56] Parrilla C, Valenza V, Calo L, Passali GC, Castaldi P(2008). Is it sufficient to quantify aspiration for predicting aspiration pneumonia?. Clin Nucl Med, 33:236-239
[57] Hirose M, Komiya K, Kadota J(2014). Influence of appetite and continuation of meals on the prognosis of elderly patients who have lost swallowing function. J Palliat Medin press
[58] Teramoto S, Yamamoto H, Yamaguchi Y, Ouchi Y, Matsuse T(2004). A novel diagnostic test for the risk of aspiration pneumonia in the elderly. Chest, 125:801-802
[59] Nakagawa T, Sekizawa K, Nakajoh K, Tanji H, Arai H(2000). Silent cerebral infarction: a potential risk for pneumonia in the elderly. J Intern Med, 247:255-259
[60] Holas MA, DePippo KL, Reding MJ(1994). Aspiration and relative risk of medical complications following stroke. Arch Neurol, 51:1051-1053
[61] Galovic M, Leisi N, Muller M, Weber J, Abela E(2013). Lesion location predicts transient and extended risk of aspiration after supratentorial ischemic stroke. Stroke, 44:2760-2767
[62] Yoshino A, Ebihara T, Ebihara S, Fuji H, Sasaki H(2001). Daily oral care and risk factors for pneumonia among elderly nursing home patients. JAMA, 286:2235-2236
[63] Yoneyama T, Yoshida M, Ohrui T, Mukaiyama H, Okamoto H(2002). Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc, 50:430-433
[64] Quagliarello V, Ginter S, Han L, Van Ness P, Allore H(2005). Modifiable risk factors for nursing home-acquired pneumonia. Clin Infect Dis, 40:1-6
[65] Pae M, Meydani SN, Wu D(2012). The role of nutrition in enhancing immunity in aging. Aging Dis, 3:91-129
[66] Hazeldine J, Lord JM(2013). The impact of ageing on natural killer cell function and potential consequences for health in older adults. Ageing Res Revin press
[67] Bulow M(2012). Videofluoroscopic swallow study: techniques, signs and reports. Nestle Nutr Inst Workshop Ser, 72:43-52
[68] Ott DJ, Pikna LA(1993). Clinical and videofluoroscopic evaluation of swallowing disorders. AJR Am J Roentgenol, 161:507-513
[69] Robbins J(1996). Normal swallowing and aging. Semin Neurol, 16:309-317
[70] Matsuse T, Oka T, Kida K, Fukuchi Y(1996). Importance of diffuse aspiration bronchiolitis caused by chronic occult aspiration in the elderly. Chest, 110:1289-1293
[71] Kikuchi R, Watabe N, Konno T, Mishina N, Sekizawa K(1994). High incidence of silent aspiration in elderly patients with community-acquired pneumonia. Am J Respir Crit Care Med, 150:251-253
[72] Esayag Y, Nikitin I, Bar-Ziv J, Cytter R, Hadas-Halpern I(2010). Diagnostic value of chest radiographs in bedridden patients suspected of having pneumonia. Am J Med, 123:e81-85
[73] Komiya K, Ishii H, Umeki K, Kawamura T, Okada F(2013). Computed tomography findings of aspiration pneumonia in 53 patients. Geriatr Gerontol Int, 13:580-585
[74] Ewig S, Welte T, Torres A(2012). Is healthcare-associated pneumonia a distinct entity needing specific therapy?. Curr Opin Infect Dis, 25:166-175
[75] Jeong BH, Koh WJ, Yoo H, Um SW, Suh GY(2013). Performances of prognostic scoring systems in patients with healthcare-associated pneumonia. Clin Infect Dis, 56:625-632
[76] Carrabba M, Zarantonello M, Bonara P, Hu C, Minonzio F(2012). Severity assessment of healthcare-associated pneumonia and pneumonia in immunosuppression. Eur Respir J, 40:1201-1210
[77] Lujan M, Gallego M, Rello J(2009). Healthcare-associated infections. A useful concept?. Curr Opin Crit Care, 15:419-424
[78] Riquelme R, Torres A, El-Ebiary M, de la Bellacasa JP, Estruch R(1996). Community-acquired pneumonia in the elderly: A multivariate analysis of risk and prognostic factors. Am J Respir Crit Care Med, 154:1450-1455
[79] Allewelt M, Schuler P, Bolcskei PL, Mauch H, Lode H(2004). Ampicillin + sulbactam vs clindamycin +/− cephalosporin for the treatment of aspiration pneumonia and primary lung abscess. Clin Microbiol Infect, 10:163-170
[80] Kadowaki M, Demura Y, Mizuno S, Uesaka D, Ameshima S(2005). Reappraisal of clindamycin IV monotherapy for treatment of mild-to-moderate aspiration pneumonia in elderly patients. Chest, 127:1276-1282
[81] Ott SR, Allewelt M, Lorenz J, Reimnitz P, Lode HGerman Lung Abscess Study G2008). Moxifloxacin vs ampicillin/sulbactam in aspiration pneumonia and primary lung abscess. Infection, 36:23-30
[82] Galvin S, Dolan A, Cahill O, Daniels S, Humphreys H(2012). Microbial monitoring of the hospital environment: why and how?. J Hosp Infect, 82:143-151
[83] Steele CM(2012). Exercise-based approaches to dysphagia rehabilitation. Nestle Nutr Inst Workshop Ser, 72:109-117
[84] Van der Maarel-Wierink CD, Vanobbergen JN, Bronkhorst EM, Schols JM, de Baat C(2011). Risk factors for aspiration pneumonia in frail older people: a systematic literature review. J Am Med Dir Assoc, 12:344-354
[85] Arai T, Yasuda Y, Takaya T, Toshima S, Kashiki Y(1998). ACE inhibitors and symptomless dysphagia. Lancet, 352:115-116
[86] Sekizawa K, Matsui T, Nakagawa T, Nakayama K, Sasaki H(1998). ACE inhibitors and pneumonia. Lancet, 352:1069
[87] Bosch X, Formiga F, Cuerpo S, Torres B, Roson B(2012). Aspiration pneumonia in old patients with dementia. Prognostic factors of mortality. Eur J Intern Med, 23:720-726
[88] Teramoto S, Yamamoto H, Yamaguchi Y, Ishii M, Hibi S(2008). Antiplatelet cilostazol, an inhibitor of type III phosphodiesterase, improves swallowing function in patients with a history of stroke. J Am Geriatr Soc, 56:1153-1154
[89] Talaie H, Jabari HR, Shadnia S, Pajouhmand A, Nava-Ocampo AA(2008). Cefepime/clindamycin vs. ceftriaxone/clindamycin for the empiric treatment of poisoned patients with aspiration pneumonia. Acta Biomed, 79:117-122
[90] Komiya K, Kadota JI(2013). C-reactive protein as a prognostic factor in elderly patients with aspiration pneumonia. Eur J Intern Med, 24:e88-9
[91] Falcone M, Corrao S, Venditti M, Serra P, Licata G(2011). Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia. Intern Emerg Med, 6:431-436
[92] Komiya K, Ishii H, Kushima H, Sato S, Kimura H(2013). Physicians’ attitudes toward the definition of “death from age-related physical debility” in deceased elderly with aspiration pneumonia. Geriatr Gerontol Int, 13:586-590
[93] Finucane TE, Christmas C, Travis K(1999). Tube feeding in patients with advanced dementia: a review of the evidence. JAMA, 282:1365-1370
[94] Dharmarajan TS, Unnikrishnan D, Pitchumoni CS(2001). Percutaneous endoscopic gastrostomy and outcome in dementia. Am J Gastroenterol, 96:2556-2563
[95] Galicia-Castillo M(2006). The PEG dilemma: feeding tubes are not the answer in advanced dementia. Geriatrics, 61:12-13
[96] Komiya K, Ishii H, Okabe E, Iwashita T, Miyajima H(2013). Risk factors for unexpected death from suffocation in elderly patients hospitalized for pneumonia. Geriatr Gerontol Int, 13:388-392
[97] Komiya K, Ishii H, Teramoto S, Yasuda T, Sato S(2012). Medical professionals’ attitudes toward tube feeding for themselves or their families: a multicenter survey in Japan. J Palliat Med, 15:561-566
[98] Solomon MZ, O’Donnell L, Jennings B, Guilfoy V, Wolf SM(1993). Decisions near the end of life: professional views on life-sustaining treatments. Am J Public Health, 83:14-23
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