Exploration of the Oral Microbiome in Non-Ventilated Hospitalized Patients

项目摘要 非呼吸机医院获得性肺炎（NV-HAP）是一种流行的医疗保健相关感染， 占所有医疗相关肺炎病例的60%。NV-HAP与不良患者相关 结果包括住院时间从4.0天增加到15.9天，死亡率从13.1%增加到30.0%， 每宗个案的费用由二万八千元至四万元不等。NV-HAP的发展存在多种风险因素， 包括口腔健康不良、口腔微生物群、年龄增加和住在疗养院。虽然一致 口腔护理是预防NV-HAP的有效措施，不同类型的口腔护理对NV-HAP的影响 口腔微生物组和NV-HAP尚未在非通气患者中进行系统研究。在探索之前 干预措施，在非通气患者住院期间口腔微生物组如何改变的基线知识 病人必须建立。环境会影响口腔微生物群，因此， 来自疗养院医院的口腔样本可能与来自家庭的口腔样本具有不同的基线， 可能导致更糟糕的结果。这项前瞻性的观察性研究将：（1）纵向探索 非通气住院患者口腔微生物组的变化;（2）探讨 院前住所（疗养院与家庭）和未通气患者的基线口腔微生物组;以及 (3)探索口腔微生物组与NV-HAP发展之间的关系。研究招募和 数据收集将在奥兰多地区医疗中心的两个渐进式护理单位进行。我们的目标是招募 70名受试者在入院72小时内从疗养院或家庭，他们不是 通风良好，年龄> 65岁。人口统计学和纵向临床数据将从 电子病历（EMR）和/或患者。将记录院前住院和NV-HAP数据 电子病历将在入组时（住院后72小时内）采集基线口腔唾液样本 入院）和第3、5和7天，或患者出院前即刻。口腔样本将由 PI到中央佛罗里达大学基因组集群实验室进行分析。分析指标将包括 细菌分类鉴定、α多样性和β多样性。拟议的培训计划将提供 研究员有机会与多学科团队合作，以建立在她的研究计划，在非 为住院患者进行通气，并最终成为一名独立的护士科学家。该研究支持 NINR的首要目标是促进创新和培养未来的护士科学家。拟定研究 也与NIH精准医学计划高度相关，告知临床医生是否有特定的口服药物， 微生物定植和院前居住使患者处于发生NV-HAP的更大风险， 这将有助于制定个性化的预防措施。这些发现将推动科学 了解住院期间口腔微生物组如何变化，从而实现长期目标， 改善非通气住院患者的健康和预后。

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.