Role of pathogenic oral flora in postoperative pneumonia following brain surgery

Abstract

BackgroundPost-operative pulmonary infection often appears to result from aspiration of pathogens colonizing the oral cavity. It was hypothesized that impaired periodontal status and pathogenic oral bacteria significantly contribute to development of aspiration pneumonia following neurosurgical operations. Further, the prophylactic effects of a single dose preoperative cefazolin on the oral bacteria were investigated.MethodsA matched cohort of 18 patients without postoperative lung complications was compared to 5 patients who developed pneumonia within 48 hours after brain surgery. Patients waiting for elective operation of a single brain tumor underwent dental examination and saliva collection before surgery. Bacteria from saliva cultures were isolated and periodontal disease was scored according to type and severity. Patients received 15 mg/kg cefazolin intravenously at the beginning of surgery. Serum, saliva and bronchial secretion were collected promptly after the operation. The minimal inhibitory concentrations of cefazolin regarding the isolated bacteria were determined. The actual antibiotic concentrations in serum, saliva and bronchial secretion were measured by capillary electrophoresis upon completion of surgery. Bacteria were isolated again from the sputum of postoperative pneumonia patients.ResultsThe number and severity of coexisting periodontal diseases were significantly greater in patients with postoperative pneumonia in comparison to the control group (p = 0.031 and p = 0.002, respectively). The relative risk of developing postoperative pneumonia in high periodontal score patients was 3.5 greater than in patients who had low periodontal score (p < 0.0001). Cefazolin concentration in saliva and bronchial secretion remained below detectable levels in every patient.ConclusionPresence of multiple periodontal diseases and pathogenic bacteria in the saliva are important predisposing factors of postoperative aspiration pneumonia in patients after brain surgery. The low penetration rate of cefazolin into the saliva indicates that its prophylactic administration may not be sufficient to prevent postoperative aspiration pneumonia. Our study suggests that dental examination may be warranted in order to identify patients at high risk of developing postoperative respiratory infections.

The Association Between Oral Microorgansims and Aspiration Pneumonia in the Institutionalized Elderly: Review and Recommendations

“…Of 23 patients evaluated after brain surgery [16], 5 developed postoperative aspiration pneumonia and were compared to the other 18 patients without postoperative lung complications with respect to their preoperative periodontal status and oral bacterial profile. Preoperative dental exams were performed to quantify the severity of the periodontal disease using a numeric scoring system.…”

Bacterial Pneumonia in Patients with Cancer

“…Oral mucositis and esophagitis commonly affect patients with hematologic malignancies or those receiving stem cell transplantation, also causing impairments of swallow function that result in bacterial pneumonias. Interestingly, while the oral microbial diversity of cancer patients does not much differ from the general population, the incidence of periodontal disease is significantly greater in those undergoing cancer chemotherapy [47-49]. It has been subsequently suggested that optimized dental care in patients receiving chemotherapy may reduce the incidence of aspiration events and reduce the frequency of fever, productive cough and positive blood cultures [50].…”

Preoperative periodontal treatment and its effects on postoperative infection in cardiac valve surgery

“…Oral bacteria are reported pathogens for pneumonia (El-Solh et al, 2004;Terpenning et al, 2001), and periodontitis severity has been associated with pneumonia mortality (Awano et al, 2008) and postoperative pneumonia onset (Bagyi et al, 2009). Pneumonia is also highly prevalent among postoperative infections in patients undergoing major heart surgery (Bouza et al, 2006;Hortal et al, 2009).…”

“…As a chronic oral inflammatory disease, periodontitis has strong associations with diabetes, arteriosclerotic disease, rheumatism, infective endocarditis (IE), pneumonia, and other systemic inflammatory conditions (Bagyi et al, 2009;Hajishengallis, 2015;Nishimura et al, 2017;Saengtipbovorn & Taneepanichskul, 2014;Sfyroeras, Roussas, Saleptsis, Argyriou, & Giannoukas, 2012). Bacteremia develops easily in patients with periodontitis with dental treatment, tooth brushing, or even mastication (Nishimura et al, 2017) when periodontal bacteria penetrate into the microvessels of periodontal pockets.…”