Exploration of the Oral Microbiome in Non-Ventilated Hospitalized Patients

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Project Summary Non-ventilator hospital acquired pneumonia (NV-HAP) is a prevalent healthcare-associated infection, accounting for 60% of all healthcare-associated pneumonia cases. NV-HAP is associated with poor patient outcomes including an increased hospital length of stay from 4.0 to 15.9 days, mortality rates of 13.1 to 30.0%, and costs ranging from $28,000 to $40,000 per case. Multiple risk factors exist for NV-HAP development, including poor oral health, oral microbiota, increased age, and residing in a nursing home. Although consistent oral care is an effective preventive measure against NV-HAP, the impact of different types of oral care on the oral microbiome and NV-HAP has not been systematically studied in non-ventilated patients. Before exploring interventions, a baseline knowledge of how the oral microbiome alters during hospitalization in non-ventilated patients must be established. The environment influences oral microbiota, thus patients admitted to the hospital from a nursing home may have a different baseline oral specimen than those admitted from home, potentially leading to worse outcomes. This prospective, observational study will: (1) Longitudinally explore changes in the oral microbiome of non-ventilated hospitalized patients; (2) Explore the relationship between pre-hospital residence (nursing home versus home) and non-ventilated patient’s baseline oral microbiome; and (3) Explore the relationship between the oral microbiome and NV-HAP development. Study recruitment and data collection will occur in two progressive care units at Orlando Regional Medical Center. We aim to recruit 70 participants within 72 hours of hospital admission from either a nursing home or home, who are non- ventilated, and > 65 years of age. Demographic and longitudinal clinical data will be collected from the electronic medical record (EMR) and/or patients. Pre-hospital residence and NV-HAP data will be recorded from the EMR. Baseline oral salivary specimens will be obtained at enrollment (within 72 hours of hospital admission) and days 3, 5, and 7, or immediately before patient discharge. Oral specimens will be taken by the PI to the University of Central Florida Genomics Cluster laboratory for analysis. Analyses metrics will include bacterial taxonomy identification, alpha-diversity, and beta-diversity. The proposed training plan will provide the fellow with an opportunity to work with a multi-disciplinary team to build upon her program of research in non- ventilated hospitalized patients and ultimately become an independent nurse scientist. This study supports the NINR’s overarching goals of promoting innovation and developing future nurse scientists. The proposed study is also highly relevant to the NIH Precision Medicine Initiative by informing clinicians of whether specific oral microbial colonization and pre-hospital residence place a patient at a greater risk for NV-HAP development, which will aid in the development of individualized preventive measures. Findings will advance the scientific knowledge of how the oral microbiome alters during hospitalization, thus working towards the long-term goal of improving the health and outcomes of non-ventilated hospitalized patients.