The role of oral microbial colonization in ventilator-associated pneumonia

Brennan, Michael T.; Bahrani-Mougeot, Farah K.; Fox, Philip C.; Kennedy, Thomas P.; Hopkins, Samuel B.; Boucher, Richard C.; Lockhart, Peter B.

doi:10.1016/j.tripleo.2004.06.005

Cited by 57 publications

(50 citation statements)

References 74 publications

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“…(1) The use of antiseptics in oral hygiene has also been the object of investigation. (6,(9)(10)(11)(12)(13) Among the products used is chlorhexidine, an antimicrobial agent with a broad spectrum of activity against gram-positive bacilli, including oxacillin-resistant S. aureus and vancomycin-resistant Enterococcus sp., and lower efficacy against gram-negative bacilli. It is absorbed by the tissues and has a residual effect over time, presenting activity even 5 h after administration.…”

Section: Resultsmentioning

confidence: 99%

“…(14,15) Various aspects affect oral cavity hygiene and further favor microbial growth, such as difficulty in or impossibility of self-care, presence of tracheal tube, which makes access to the oral cavity difficult, and the consequent formation of dental plaque biofilm. (10)(11)(12)16) The Centers for Disease Control and Prevention (CDC) recommends oral hygiene with chlorhexidine in patients in the perioperative period of cardiac surgery. However, regarding medicalsurgical ICU patients, the theme is considered an unresolved question.…”

Section: Resultsmentioning

confidence: 99%

“…and Staphylococcus aureus are frequently isolated. (6,7) Considering that the microbiota of the oral cavity represents a threat to critical patients, (2,4,(8)(9)(10)(11)(12) some strate- …”

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confidence: 99%

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Higiene bucal com clorexidina na prevenção de pneumonia associada à ventilação mecânica

Beraldo

Andrade

2008

J. bras. pneumol.

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those that favor the colonization of the oropharynx or the stomach, the aspiration of secretions into the lower respiratory tract or reflux of the gastrointestinal tract, and factors inherent in the host. (2,4,5) The bacterial agent found will depend on length of hospital stay, use of antimicrobial agents, host susceptibility, and ICU microbiota. Gram-negative bacilli (Pseudomonas aeruginosa, Proteus spp., Acinetobacter spp.) and Staphylococcus aureus are frequently isolated. (6,7) Considering that the microbiota of the oral cavity represents a threat to critical patients, (2,4,(8)(9)(10)(11)(12) some strate- IntroductionVentilator-associated pneumonia (VAP) is defined as that developing in the period from 48 h after initiation of mechanical ventilation to 48 h after extubation. It is one of the most common cross infections in intensive care units (ICUs), with rates that range from 9 to 40% of the infections acquired in these units, and is associated with an increase in length of hospitalization and in morbidity and mortality rates, which significantly affects costs. (1)(2)(3) The aspiration of microorganisms present in the oropharynx constitutes the most common means of acquiring the disease, and the principal risk factors are AbstractVentilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs), and oral antiseptic is used as a preventive measure. We reviewed meta-analyses and randomized clinical trials indexed in the Medical Literature Analysis and Retrieval System and Cumulative Index to Nursing and Allied Health Literature databases regarding the topical use of chlorhexidine in the prevention of VAP. Eight publications were analyzed. In seven (87.5%) chlorhexidine diminished the colonization of the oropharynx, and in four (50%) there was a reduction of VAP. Chlorhexidine seems to reduce colonization, thus reducing the incidence of VAP.Keywords: Pneumonia, ventilator-associated; Oral hygiene; Chlorhexidine. ResumoA pneumonia associada à ventilação mecânica (PAVM) é uma infecção freqüente nas unidades de terapia intensiva (UTI), e anti-sépticos bucais são utilizados preventivamente. Revisamos metanálises e ensaios clínicos randomizados indexados no Medical Literature Analysis and Retrieval System e Cumulative Index to Nursing and Allied Health Literature sobre o uso tópico da clorexidina na prevenção da PAVM.Oito publicações foram avaliadas. Em sete (87,5%), a clorexidina diminuiu a colonização da orofaringe, e em quatro (50%) houve redução de PAVM. A clorexidina parece diminuir a colonização, podendo reduzir a incidência da PAVM.Descritores: Pneumonia associada à ventilação mecânica; Higiene bucal; Clorexidina.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Higiene bucal com clorexidina na prevenção de pneumonia associada à ventilação mecânica

Beraldo

Andrade

2008

J. bras. pneumol.

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“…strains in NICU (4,25). Unlike healthy patients (26), gram-negative bacilli such as Pseudomonas aeruginosa are typically observed in the oropharynx of critically ill hospitalized patients (22,27). These bacilli are gram-negative and are considered to be associated with the onset of nosocomial pneumonia (28).…”

Section: Discussionmentioning

confidence: 99%

Microbial investigations in throat swab and tracheal aspirate specimens are beneficial to predict the corresponding endotracheal tube biofilm flora among intubated neonates with ventilator-associated pneumonia

Pan

Ai³

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Ventilator-associated pneumonia (VAP) is a common nosocomial infection in neonatal intensive care units with high morbidity and mortality. Bacterial biofilm in the endotracheal tube (ET) provides a notable and persistent source of pathogens that may cause VAP, and thus is important for VAP detection. However, during intubation microbial investigations in ET, samples are unavailable due to the infeasibility of collecting ET samples during intubation of neonates. It is therefore of great importance to find alternative sources of samples that can help identify the ET biofilm flora. In the present study, the microbial signatures of throat swabs and tracheal aspirates were compared with ET biofilm samples from VAP neonates using 16S ribosomal RNA gene polymerase chain reaction, denaturing gradient gel electrophoresis (DGGE), cloning and sequencing. Sequences were assigned to phylogenetic species using BLAST. Microbial diversity and richness among the three types of specimens were compared based on their DGGE fingerprints, and taxonomic characteristics based on the BLAST results. The microbial richness and diversity of ET biofilms were similar to tracheal aspirate yet significantly different from throat swab samples (P<0.05). Compared with ET biofilms, the overall constituent ratio of microflora was significantly different in throat swab and tracheal aspirate samples (P<0.05). However tracheal aspirate samples were useful for predicting Staphylococcus sp. in ET biofilms with a sensitivity of 85.7% and a specificity of 83.3%. The sensitivity for the combination of tracheal aspirate and throat swab samples to detect Staphylococcus sp. in ET biofilms was 100%. The detection of Pseudomonas sp. in throat swabs assisted its identification in ET biofilms (sensitivity 33.3% and specificity 100%). The results of the present study suggest that microbial investigations in throat swab and tracheal aspirate samples are beneficial for identifying the ET biofilm flora. There may therefore be clinical applications of using substituent samples to identify pathogens in ET biofilms for VAP surveillance among intubated neonates.

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“…This evaluation suggested that it was likely that the dorsum of the tongue acted as a reservoir of bacteria that are pathogenic for the respiratory tract and involved in VAP. (1,36,37) Isolates of S. aureus, P. aeruginosa, Acinetobacter spp. and enteric species collected from the dental plaque of patients with VAP can be indistinguishable from isolates collected from the bronchoalveolar fluid, which reinforces this observation.…”

Section: Pathogenesis Of Nosocomial Pneumonia and Importance Of The Omentioning

confidence: 99%

Pneumonia nosocomial: importância do microambiente oral

2009

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on average, 5-9 days the length of hospital stay of patients, nosocomial pneumonia markedly increases hospital costs. (5)(6)(7)(8) The use of oral antiseptic and antimicrobial agents to prevent nosocomial pneumonia has been widely studied and, based on what has been reported, the present study aimed to review the literature focusing on how oral microorganisms can influence the development of nosocomial pneumonia and on how the frequency of nosocomial pneumonia can be reduced by changing the oral environment. DefinitionsPneumonia is an acute lung infection, which can produce respiratory signs and symptoms, such as cough, short and fast breathing, production of secretion and chest pain, as well as non-specific systemic symptoms, such as fever, IntroductionPeriodontal medicine appeared based on studies that reported the direct relationship between periodontal disease and a number of systemic morbidities, such as atherosclerosis, acute myocardial infarction, preterm birth, low birth weight, respiratory problems, gastritis, endocarditis and bacteremia.(1-3) Within this group of diseases, nosocomial pneumonia has been increasingly studied, and the relationship between nosocomial pneumonia and microorganisms from the oral cavity has been increasingly acknowledged.Patients submitted to cardiac surgery have a particularly high risk of developing nosocomial pneumonia; in these patients, the incidence of nosocomial pneumonia can be as high as 20%, and the disease is significantly associated with mortality.(4) The risk of developing nosocomial pneumonia increases with the need for mechanical ventilation and, in addition to prolonging, AbstractNosocomial pneumonia, especially ventilator-associated pneumonia, is a common infection in ICUs. The main etiologic factors involve colonizing and opportunistic bacteria from the oral cavity. Oral hygiene measures, including the use of oral antiseptic agents, such as chlorhexidine, have proven useful in reducing its incidence. The objective of this article was to review the literature on the importance of the oral environment in the development of nosocomial pneumonia.Keywords: Intensive care; Oral hygiene; Cross infection; Pneumonia. ResumoA pneumonia nosocomial, em especial aquela associada à ventilação mecânica, é uma infecção frequente nas UTIs. Seus principais fatores etiológicos incluem bactérias colonizadoras e oportunistas da cavidade oral. Manobras de higiene oral, com o uso de antissépticos orais, como a clorexidina, têm se mostrado úteis na diminuição de sua incidência. O objetivo deste trabalho foi revisar a literatura sobre a importância do microambiente oral no desenvolvimento da pneumonia nosocomial.

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The role of oral microbial colonization in ventilator-associated pneumonia

Cited by 57 publications

References 74 publications

Higiene bucal com clorexidina na prevenção de pneumonia associada à ventilação mecânica

Higiene bucal com clorexidina na prevenção de pneumonia associada à ventilação mecânica

Microbial investigations in throat swab and tracheal aspirate specimens are beneficial to predict the corresponding endotracheal tube biofilm flora among intubated neonates with ventilator-associated pneumonia

Pneumonia nosocomial: importância do microambiente oral

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