Dental and Microbiological Risk Factors for Hospital-Acquired Pneumonia in Non-Ventilated Older Patients
Dental and Microbiological Risk Factors for Hospital-Acquired Pneumonia in Non-Ventilated Older Patients
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DOI：
10.1371/journal.pone.0123622
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发表时间：
2015-04-29
期刊：
影响因子：
3.7
通讯作者：
Newton, Julia L.
中科院分区：
文献类型：
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作者：
Ewan, Victoria C.;Sails, Andrew D.;Newton, Julia L.
医院获得性肺炎（HAP）在老年患者中往往是致命的。口腔是主要的感染源，研究表明口腔卫生干预可以预防HAP。本研究的目的是调查HAP和前a）沉重的牙菌斑和B）口腔携带潜在的呼吸道病原体的老年下肢骨折患者之间的关联，以确定干预研究的目标。2009年4月至2010年7月期间，65-101岁，在英格兰东北部的一家综合医院接受治疗。我们使用新型的实时多重PCR检测S。aureus、MRSA、E. coli、铜绿假单胞菌、S. pneumoniae，H.流感和不动杆菌属我们收集的数据牙/义齿菌斑（修改后的Quigley-Hein指数）和临床医生诊断的HAP.ResultsThe粗发病率HAP为10%（n = 90），出院后90天的死亡率为80%。50%的病例发生在最初的25天内。HAP与牙齿、牙齿数量或重度牙菌斑/义齿菌斑无关。HAP与既往经口携带大肠杆菌有关。coli/S.金黄色葡萄球菌/铜绿假单胞菌/MRSA（p = 0.002，OR 9.48 95% CI 2.28-38.78）。HAP在携带者中的发生率为35%（未携带者为4%），相对危险度为6.44（95%CI 2.04-20.34，p = 0.002）。HAP与住院时间延长相关（Fisher精确检验，p=0.01），平均延长30天（范围-11.5-115）。90%的受试者在入院后72小时内首次检测到目标微生物，但HAP与S。金黄色葡萄球菌/MRSA/铜绿假单胞菌/E.在第5天（OR 4.39，95% CI 1.73 -11.16）或第14天（OR 6.69，95% CI 2.40-18.60）检出大肠埃希菌。coli/S.金黄色葡萄球菌/MRSA/铜绿假单胞菌在住院5天后发生HAP的风险显著更高（p = 0.002）。
Hospital acquired pneumonia (HAP) is often fatal in older patients. The mouth is the main reservoir of infection and studies have suggested that oral hygiene interventions may prevent HAP. The aim of this study was to investigate associations between HAP and preceding a) heavy dental plaque and b) oral carriage of potential respiratory pathogens in older patients with lower limb fracture to determine the target for intervention studies.MethodsWe obtained a time series of tongue/throat swabs from 90 patients with lower limb fracture, aged 65-101 in a general hospital in the North East of England between April 2009-July 2010. We used novel real-time multiplex PCR assays to detect S. aureus, MRSA, E. coli, P. aeruginosa, S. pneumoniae, H. influenza and Acinetobacter spp. We collected data on dental/denture plaque (modified Quigley-Hein index) and outcomes of clinician-diagnosed HAP.ResultsThe crude incidence of HAP was 10% (n = 90), with mortality of 80% at 90 days post discharge. 50% of cases occurred within the first 25 days. HAP was not associated with being dentate, tooth number, or heavy dental/denture plaque. HAP was associated with prior oral carriage with E. coli/S. aureus/P. aeruginosa/MRSA (p = 0.002, OR 9.48 95% CI 2.28-38.78). The incidence of HAP in those with carriage was 35% (4% without), with relative risk 6.44 (95% CI 2.04-20.34, p = 0.002). HAP was associated with increased length of stay (Fishers exact test, p=0.01), with mean 30 excess days (range -11.5-115). Target organisms were first detected within 72 hours of admission in 90% participants, but HAP was significantly associated with S. aureus/MRSA/P. aeruginosa/E. coli being detected at days 5 (OR 4.39, 95% CI1.73-11.16) or 14 (OR 6.69, 95% CI 2.40-18.60).ConclusionsPatients with lower limb fracture who were colonised orally with E. coli/S. aureus/MRSA/P. aeruginosa after 5 days in hospital were at significantly greater risk of HAP (p = 0.002).