Epidemiology
- Definition of Near Drowning: defined as submersion in water severe enough to require medical attention
- WHO Definition of Drowning: “the process of experiencing respiratory impairment from immersion/immersion in liquid”
- Mortality Rates Associated with Drowning
- Worldwide: 500k deaths (or 0.7% of all deaths) occur annually due to unintentional drowning
- US: 8k deaths occur annually due to unintentional drowning
- Near drowning is believed to occur 2-20x more frequently
Organisms Associated with Pneumonia After Near Drowning
- Aeromonas Hydrophila (see Aeromonas, [[Aeromonas]]): most commonly isolated Aeromonas species in near drowning cases
- 70% of cases have a bacteremic pneumonia
- Associated with near drowning in both fresh and salt water cases
- Virulent infection: >70% of cases have bacteremia and mortality rates are close to 60%
- Highest risk in those with liver disease and hematologic malignancies
- Aspergillus (see Aspergillus, [[Aspergillus]])): common fungal contaminant of natural bodies of water, especially those polluted with sewage)
- Invasive Aspergillosis cases have been reported
- Rare etiology
- Usually associated with near drowning near sewage or in polluted water, stagnant water, or muddy water
- Chromobacterium Violaceum (see Chromobacterium Violaceum, [[Chromobacterium Violaceum]])
- Epidemiology: found in soil and freshwater in Southeast USA
- Few case reports of near drowning-associated pneumonia
- Francisella Philomiragia (see Francisella Philomiragia, [[Francisella Philomiragia]]): few reports (all associated with salt water near drowning cases)
- Klebsiella Pneumoniae (see Klebsiella Pneumoniae, [[Klebsiella Pneumoniae]]): has been associated with salt water near drowning cases
- Non-Cholera Vibrio Species (see Vibrio, [[Vibrio]])
- Oral Anerobes
Pneumoniae”>Streptococcus Pneumoniae, [[Streptococcus Pneumoniae]])
- Pseudoallescheria Boydii (Scedosporium Apiosperium) (see Scedosporiosis, [[Scedosporiosis]]): found in freshwater lakes, coastal waters, and polluted streams): most common fungus associated with near drowning
- More common etiology of pneumonia after near drowning than Aspergillus
- Associated with near drowning in both coastal and fresh water, as well as in polluted or contaminated water
- May also cause meningitis/brain abscess
- Staphylococcus Aureus (see Staphylococcus Aureus, [[Staphylococcus Aureus]])
- Streptococcus Pneumoniae (see Disseminated Intravascular Coagulation, [[Disseminated Intravascular Coagulation]])
Neurologic Manifestations
Anoxic Encephalopathy
Pulmonary Manifestations
Pneumonia (see Pneumonia, [[Pneumonia]])
- Epidemiology
- Incidence of Pneumonia After Near-Drowning: 12%
- Clinical: may occur immediately or days-weeks after initial submersion event
Acute Lung Injury-ARDS Acute Lung Injury-ARDS, [[Acute Lung Injury-ARDS]])
Renal Manifestations
Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]])
Other Manifestations
- Organ Dysfunction: due to hypoxia/acidosis/ischemia
- Includes ARDS/cardiogenic shock
Treatment
Supportive Care
- Mechanical Ventilation: as required
Antibiotics
- General Comments: since incidence of pneumonia after near-drowning is only 12%, it is recommended to withhold antibiotics and monitor patient daily for fever/infiltrates/leukocytosis
Treatment of Specific Pathogens
- Aeromonas Species (see Aeromonas, [[Aeromonas]]): most are susceptible to aminoglycosides, extended-spectrum penicillins, 3rd generation cephalosporins, carbapenems, aztreonam, trimethoprim-sulfamethoxazole, and fluoroquinolones.
- Francisella Philomiragia (see xxxx, [[xxxx]]): sensitive to extended spectrum cephalosporins, fluoroquinolones, aminoglycosides, chloramphenicol, and tetracyclines
- Pseudoallescheria Boydi (Scedosporium Apiospermium) (see Scedosporiosis, [[Scedosporiosis]]): miconazole has the best in vivo activity against P boydii and the drug is usually given IV and intraventricularly in patients with central nervous system involvement
References
- Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary: BET 1: prophylactic antibiotics in near-drowning. Emerg Med J 2010;27:393-394 [MEDLINE]
- Use of CPR in cases of drowning. N Engl J Med 2012;366:2102-2110 [MEDLINE]