Association between pathogens from tracheal aspirate and oral biofilm of patients on mechanical ventilation

Abstract

The aim of this study was to detect possible associations between respiratory pathogens from tracheal aspirate and oral biofilm samples in intubated patients in an intensive care unit (ICU), and to identify the most common respiratory pathogens in oral biofilm, particularly in patients that developed ventilator-associated pneumonia (VAP). Two oral biofilm samples were collected from the tongue of intubated patients (at admission and after 48 hours) and analyzed by culture with the Antibiotic Sensitivity Test. The results from the tongue biofilm samples were compared with the tracheal secretions samples. A total of 59.37% of patients exhibited the same species of pathogens in their tracheal aspirate and oral biofilm, of which 8 (42.1%) developed VAP, 10 (52.63%) did not develop pneumonia and one (5.26%) had aspiration pneumonia. There was a statistically significant association between presence of microorganisms in the tracheal and mouth samples for the following pathogens: Klebsiella pneumoniae, Candida albicans, Pseudomonas aeruginosa, Enterobacter gergoviae, Streptococcus spp and Serratia marcescens (p < 0.05). Pathogens that are present in tracheal aspirates of intubated patients can be detected in their oral cavity, especially in those who developed VAP or aspiration pneumonia. Thus, the results indicate that an improved oral care in these patients could decrease ICU pneumonia rates.

Diagnostic Value of Endotracheal Aspirates Sonication on Ventilator-Associated Pneumonia Microbiologic Diagnosis

“…Our findings are relevant as they imply that we may be sub-optimally utilizing existing diagnostic technology if we do not disaggregate bacteria from their biofilms before ETA culture. Considering the latest advancements in point-of-care diagnosis [ 36 ] and that biofilm forming species of the respiratory microbiome can trigger pathogen growth [ 22 , 37 , 38 ], this seems the appropriate time to reconsider the diagnosis of biofilms in respiratory samples from intubated ICU patients with suspicion of VAP.…”

Endotracheal Tube Biofilm and its Impact on the Pathogenesis of Ventilator-Associated Pneumonia

“…Respiratory pathogens are not usually found in the oral microbiota of healthy people, but hospitalized patients are susceptible to oral biofilm colonization by these microorganisms [39]. Improved oral hygiene has been proven to be an effective strategy of VAP prevention, taking into consideration that normal oral microflora may represent pioneering colonizing species and potential respiratory pathogen may be isolated from dental plaque’s biofilm [7, 39]. Chemical control of oral pathogens seems to be more effective than mechanical removal [39].…”

Boas práticas de enfermagem a pacientes em ventilação mecânica invasiva na emergência hospitalara

“…Pathogens present in tracheal aspirate from intubated patients were detected in the lingual biofilm, especially in those with PAMV or aspiration pneumonia, suggesting that improving oral hygiene in MV patients may reduce pneumonia rates. 32 For the removal of dental plaque and other debris from the teeth, tongue and oral mucosa a swab or toothbrush with minimal water to reduce the volume of any aspirated material can be used. 33 Tracheal intubation and immobility imposed on the patient by sedation reduce mucociliary transport and promote retention of airway secretions.…”