Colonization of dental plaques - A reservoir of respiratory pathogens for hospital acquired pneumonia in institutionalized elders

Division of Pulmonary, Critical Care, and Sleep Medicine, Erie County Medical Center, 462 Grider St, Buffalo, NY 14215, USA.
Chest (Impact Factor: 7.48). 11/2004; 126(5):1575-82. DOI: 10.1378/chest.126.5.1575
Source: PubMed


Poor dental hygiene has been linked to respiratory pathogen colonization in residents of long-term care facilities. We sought to investigate the association between dental plaque (DP) colonization and lower respiratory tract infection in hospitalized institutionalized elders using molecular genotyping.
We assessed the dental status of 49 critically ill residents of long-term care facilities requiring intensive care treatment. Plaque index scores and quantitative cultures of DPs were obtained on ICU admission. Protected BAL (PBAL) was performed on 14 patients who developed hospital-acquired pneumonia (HAP). Respiratory pathogens recovered from the PBAL fluid were compared genetically to those isolated from DPs by pulsed-field gel electrophoresis.
Twenty-eight subjects (57%) had colonization of their DPs with aerobic pathogens. Staphylococcus aureus (45%) accounted for the majority of the isolates, followed by enteric Gram-negative bacilli (42%) and Pseudomonas aeruginosa (13%). The etiology of HAP was documented in 10 patients. Of the 13 isolates recovered from PBAL fluid, nine respiratory pathogens matched genetically those recovered from the corresponding DPs of eight patients.
These findings suggest that aerobic respiratory pathogens colonizing DPs may be an important reservoir for HAP in institutionalized elders. Future studies are needed to delineate whether daily oral hygiene in hospitalized elderly would reduce the risk of nosocomial pneumonia in this frail population.

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Available from: Joseph J. Zambon, Jun 17, 2014
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    • "The oral cavity and oropharynx deserve greater attention as a reservoir of Staphylococcus aureus. Studies suggested that the presence of S. aureus in saliva was a significant risk factor for aspiration pneumonia [24], [25]. Oral S. aureus may also serve as a reservoir for cross-infection to other patients, as well as health care staff [26]. "
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    • "Gram-negative bacteria are frequently found in the mouths of frail elders, and in the blood of patients with bacteraemia (1, 2). The pathogens isolated from patients with bacteraemia and pneumonia have been genetically matched to those in their oral biofilms (3, 4). "
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