National survey on aspiration pneumonia in elderly hospitalized or institutionalized patients in France in 2023

Aspiration pneumonia is not specifically addressed in French guidelines on pneumonia, despite it being a frequent infection affecting specific populations. The French Infectious Diseases Society's (French acronym SPILF) Recommendations Group and the Infectio-Geriatrics Group (GinGER-SPILF SFGG) have published the first recommendations on this topic in 2025. The objective of this study was to describe practices of French physicians to manage aspiration pneumonia in hospitalized or institutionalized people aged over 75 years.

A nationwide survey conducted from June to November 2023 was distributed to physicians working in hospitals or medico-social facilities to assess their habits from diagnosis to prevention.

A total of 452 physicians responded (mainly geriatricians, infectious disease specialists, and family physicians). Diagnostic criteria were consensual: presence of vomiting, swallowing disorders, or a history of inhalation pneumonia. Seventy-eight per cent of physicians reported prescribing complementary examinations. Imaging examinations (74%) were prioritized over bacteriology (19%). Oral amoxicillin-clavulanic acid was the first-line antibiotic (82%). Significant differences were found in the use of metronidazole and of the subcutaneous route, which were more frequently used by geriatricians. Geriatricians referred significantly more patients to speech therapists. The most commonly used swallowing test was the water test (92%). Screening and management of swallowing disorders, secondary prevention, and nutritional management varied according to specialties and practice settings.

This survey shows consensus regarding diagnostic criteria and antibiotic therapy. However, the significant variation in prevention and nutritional management across specialties and practice settings highlights the need for specific recommendations.