Toothbrushes may convey bacteria to the cystic fibrosis lower airways

Abstract

Recent findings indicate that the oral cavity acts as a bacterial reservoir and might contribute to the transmission of bacteria to the lower airways. Control of a potentially pathogenic microbiota might contribute to prevent the establishment of chronic infection in cystic fibrosis. We evaluated the presence of CF microorganisms in saliva and toothbrushes of CF patients and verify their possible transmission to lower airways. Methods: We assessed the presence of P. aeruginosa, S. aureus, S. maltophilia, A. xylosoxidans, S. marcescens, and yeasts in saliva, toothbrushes and sputum of 38 CF patients and assessed the clonal identity of the strains occurring contemporary in multiple sites by PFGE. Results: At least one of the investigated species was isolated from 60 saliva samples and 23 toothbrushes. S. aureus was the most abundant species, followed by Candida spp. 31 patients contemporary had the same species in sputum and saliva/toothbrush: in most cases, clonal identity of the strains among the different sites was confirmed. Conclusion: Toothbrushes may be sources of oral contamination and might act as reservoirs favoring transmission of potentially pathogenic microorganisms from the environment to the oral cavity and eventually to the LAW. Oral hygiene and toothbrush care are important strategies to prevent CF lung infections.

Steam disinfection of toothbrushes from patients with cystic fibrosis: Evidence‐based recommendations

“…Importantly, this study also demonstrated that P. aeruginosa genotyping showed two identical clones on the patients' toothbrushes and in their sputum 6 . More recently, an Italian study demonstrated that in 31 patients, these patients had contemporary the same species in sputum and saliva/toothbrush, and in most cases, the clonal identity of the strains among the different sites was confirmed 7 . Both studies concluded that effective toothbrush decontamination methods need to be developed to prevent CF lung infections.…”

“…aureus was detected in 22%, 13%, and 13% of these groups, respectively 6 . In a recent study from Italy, these pathogens were also detected in toothbrushes from patients with CF, where the authors highlight the potential role of toothbrushes as a source of oral contamination, postulating their role as a reservoir and conduit of pathogens from the environment, via the oral cavity, to the lower airways 7 . Furthermore, both studies demonstrated the presence of similar clonal types of organism found on a toothbrush and in the same patient's sputum/lower airways 6,7 …”

“…Both the French and Italian studies mentioned above 6,7 also report the presence of a diverse variety of other nonpathogenic microflora found on CF patients' toothbrushes, which would not be considered clinically significant, in that they are not usually associated with disease pathology in the patient with CF. Recent microbiome studies of toothbrushes from non‐CF healthy adults which were stored in the office showed the major genera to be Enterococcus (30.8%), Pseudomonas (21.9%), Streptococcus (14.9%), and Lactobacillus (5.2%), while in the same population of volunteers, for their toothbrushes stored in the bathroom, Streptococcus (19.7%), Pseudomonas (16.1%), Enterococcus (8.2%), and Neisseria (7%) were the predominant taxa 23 .…”

“…For patients with CF, contamination of the patient's toothbrush with their own sputum containing newly acquired pathogens is a further source of reinfection. Previous studies have shown that CF patients' toothbrushes can be a source of CF respiratory pathogens 6,7 . In 2015, a French study showed that P. aeruginosa and Sta.…”

Role of Salivary Biomarkers in Cystic Fibrosis: A Systematic Review

“…Cystic fibrosis (CF) is a life-limiting, multisystem autosomal recessive genetic disorder with a wide range of clinical and genetic variants [ 1 ]. CF most commonly affects Caucasians, with 70,000 people diagnosed worldwide [ 2 ]. It is caused by gene mutations in the CF transmembrane conductance regulator (CFTR) on the long arm of chromosome 7 that contributes to an abnormal chloride and sodium transportation across the epithelial cell membrane.…”