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Respiratory pathogen colonisation of dental plaque, the lower airways and endotracheal tube biofilms during mechanical ventilation

Sands, Kirsty M., Wilson, Melanie J., Lewis, Michael A. O., Wise, Matthew P., Palmer, Nicki, Hayes, Anthony J., Barnes, Rosemary A. and Williams, David W. 2017. Respiratory pathogen colonisation of dental plaque, the lower airways and endotracheal tube biofilms during mechanical ventilation. Journal of Critical Care 37 , pp. 30-37. 10.1016/j.jcrc.2016.07.019

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Abstract

Purpose In mechanically ventilated patients, the endotracheal tube is an essential interface between the patient and ventilator, but inadvertently, it also facilitates the development of ventilator-associated pneumonia (VAP) by subverting pulmonary host defenses. A number of investigations suggest that bacteria colonizing the oral cavity may be important in the etiology of VAP. The present study evaluated microbial changes that occurred in dental plaque and lower airways of 107 critically ill mechanically ventilated patients. Materials and Methods Dental plaque and lower airways fluid was collected during the course of mechanical ventilation, with additional samples of dental plaque obtained during the entirety of patients' hospital stay. Results A “microbial shift” occurred in dental plaque, with colonization by potential VAP pathogens, namely, Staphylococcus aureus and Pseudomonas aeruginosa in 35 patients. Post-extubation analyses revealed that 70% and 55% of patients whose dental plaque included S aureus and P aeruginosa, respectively, reverted back to having a predominantly normal oral microbiota. Respiratory pathogens were also isolated from the lower airways and within the endotracheal tube biofilms. Conclusions To the best of our knowledge, this is the largest study to date exploring oral microbial changes during both mechanical ventilation and after recovery from critical illness. Based on these findings, it was apparent that during mechanical ventilation, dental plaque represents a source of potential VAP pathogens.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Biosciences
Dentistry
Medicine
Subjects: R Medicine > R Medicine (General)
R Medicine > RK Dentistry
Uncontrolled Keywords: Mechanical ventilation; Staphylococcus aureus; Pseudomonas aeruginosa; Endotracheal tube; Endotracheal tube; Ventilator-associated pneumonia
Additional Information: This journal has an embargo period of 12 months.
Publisher: Elsevier
ISSN: 0883-9441
Date of First Compliant Deposit: 1 September 2016
Date of Acceptance: 25 July 2016
Last Modified: 20 Oct 2019 08:35
URI: http://orca.cf.ac.uk/id/eprint/94133

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