Oral Microbes in Hospital-Acquired Pneumonia: Practice and Research Implications.
Oral Microbes in Hospital-Acquired Pneumonia: Practice and Research Implications.
复制标题
医院获得性肺炎的口腔微生物：实践和研究意义。
DOI：
10.4037/ccn2022672
复制
发表时间：
2022-06-01
影响因子：
1.6
通讯作者：
Sole ML
中科院分区：
文献类型：
--
作者：
Rathbun KP;Bourgault AM;Sole ML
医院获得性肺炎占所有卫生保健相关感染的25%，并分为呼吸机相关性肺炎或非呼吸机相关性肺炎。医院获得性肺炎最常见的原因是口咽分泌物吸入肺部。虽然呼吸机相关性肺炎的预防措施已经建立，但对于非呼吸机类型的预防措施很少。目的：（1）探讨急性病、成人住院患者呼吸机相关性肺炎和非呼吸机相关性肺炎相关的口腔微生物;（2）为预防住院患者肺炎的措施提供循证建议。使用CINAHL、Academic Search Premier、Medline和科克伦图书馆进行文献检索。发现10项研究确定了呼吸机相关性和非呼吸机相关性肺炎中常见的口腔微生物，包括鲍曼不动杆菌、大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、耐甲氧西林金黄色葡萄球菌、金黄色葡萄球菌和肺炎链球菌。总的来说，大肠杆菌、铜绿假单胞菌、耐甲氧西林金黄色葡萄球菌和金黄色葡萄球菌的口服定植增加了非呼吸机肺炎的风险。研究结果还表明，口腔微生物定植到肺部的微抽吸。非呼吸机相关性肺炎的革兰氏阳性菌和革兰氏阴性菌定植率相似，而呼吸机相关性肺炎的革兰氏阴性菌定植率更高。文献并未指出口腔护理标准对所有患者人群均有效。口腔护理是通过减少病原性口腔微生物定植来预防医院获得性肺炎的有效干预措施。不同的口腔护理方法和时间对口腔微生物的影响应进一步探讨，特别是在没有接受机械通气的患者中。研究结果重申了一致的口腔护理住院患者的重要性。此外，接受机械通气的患者与未接受通气的患者的实践应有所不同。研究结果也可能为未来肺炎的预防措施提供信息，特别是对非呼吸机肺炎。
Hospital-acquired pneumonia accounts for 25% of all health care–associated infections and is classified as either ventilator-associated or non–ventilator-associated pneumonia. Hospital-acquired pneumonia most frequently results from aspiration of oropharyngeal secretions into the lungs. Although preventive measures for ventilator-associated pneumonia are well established, few preventive measures exist for the nonventilator type. To (1) explore oral microbes associated with ventilator-associated and non–ventilator-associated pneumonia in acutely ill, adult hospitalized patients, and (2) provide evidence-based recommendations for measures to prevent pneumonia in hospitalized patients. A literature search was conducted using CINAHL, Academic Search Premier, Medline, and the Cochrane Library. Ten studies were found that identified common oral microbes in ventilator-associated and non–ventilator-associated pneumonia, including Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, S aureus, and Streptococcus pneumoniae. Collectively, oral colonization with E coli, P aeruginosa, methicillin-resistant S aureus, and S aureus increased the risk of nonventilator pneumonia. Findings also suggested microaspiration of colonized oral microbes into the lungs. Non–ventilator-associated pneumonia had similar colonization rates of gram-positive and gram-negative bacteria, whereas ventilator-associated pneumonia had greater colonization with gram-negative bacteria. The literature did not indicate a standard of oral care effective in all patient populations. Oral care is an effective intervention to prevent hospital-acquired pneumonia by reducing pathogenic oral microbial colonization. The impact of different methods and timing of oral care on oral microbes should be further explored, particularly in patients not receiving mechanical ventilation. Findings reaffirm the importance of consistent oral care in hospitalized patients. In addition, practices should be different in patients receiving mechanical ventilation versus patients not receiving ventilation. Results may also provide knowledge to inform future preventive measures for pneumonia, particularly for nonventilator pneumonia.
登录
查看更多内容
影响因子：
3.7
作者：
Ewan, Victoria C.;Sails, Andrew D.;Newton, Julia L.
通讯作者：
Newton, Julia L.
影响因子：
38.9
作者：
Deschepper M;Waegeman W;Eeckloo K;Vogelaers D;Blot S
通讯作者：
Blot S
DOI：
10.1186/cc13775
发表时间：
2014-03-18
期刊：
Critical care (London, England)
影响因子：
--
作者：
Kalanuria AA;Ziai W;Mirski M
通讯作者：
Mirski M
DOI：
10.1164/ajrccm.154.5.8912745
发表时间：
1996-11-01
影响因子：
24.7
作者：
Bonten, MJM;Bergmans, DCJJ;Gaillard, CA
通讯作者：
Gaillard, CA
DOI：
10.1164/ajrccm.156.5.96-04076
发表时间：
1997-11-01
影响因子：
24.7
作者：
GarrousteOrgeas, M;Chevret, S;Schlemmer, B
通讯作者：
Schlemmer, B