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Impact of tooth brushing on oral bacteriota and health care-associated infections among ventilated COVID-19 patients: an intervention study.
Gregorczyk-Maga, Iwona; Palka, Anna; Fiema, Mateusz; Kania, Michal; Kujawska, Anna; Maga, Pawel; Jachowicz-Matczak, Estera; Romaniszyn, Dorota; Chmielarczyk, Agnieszka; Zóltowska, Barbara; Wójkowska-Mach, Jadwiga.
  • Gregorczyk-Maga I; Institute of Dentistry, Faculty of Medicine, Jagiellonian University Medical College, Ul. Montelupich 4, 31-155, Kraków, Poland.
  • Palka A; Microbiology Unit, University Hospital, Ul. Jakubowskiego 2, 30-688, Kraków, Poland.
  • Fiema M; Department of Endocrinology, University Hospital, Ul. Jakubowskiego 2, 30-688, Kraków, Poland.
  • Kania M; Doctoral School of Medicine and Health Sciences, Jagiellonian University Medical College, Ul. sw. Anny 12, 31-008, Kraków, Poland. mich.kania@doctoral.uj.edu.pl.
  • Kujawska A; Chair of Metabolic Diseases, Faculty of Medicine, Jagiellonian University Medical College, Ul. Jakubowskiego 2, 30-688, Kraków, Poland. mich.kania@doctoral.uj.edu.pl.
  • Maga P; Microbiology Unit, University Hospital, Ul. Jakubowskiego 2, 30-688, Kraków, Poland.
  • Jachowicz-Matczak E; Chair of Angiology, Faculty of Medicine, Jagiellonian University Medical College, Ul. Jakubowskiego 2, 30-688, Kraków, Poland.
  • Romaniszyn D; Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18, 31-121, Kraków, Poland.
  • Chmielarczyk A; Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18, 31-121, Kraków, Poland.
  • Zóltowska B; Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18, 31-121, Kraków, Poland.
  • Wójkowska-Mach J; Center for Innovative Therapy, Clinical Research Coordination Center, University Hospital, Ul. Jakubowskiego 2, 30-688, Kraków, Poland.
Antimicrob Resist Infect Control ; 12(1): 17, 2023 03 08.
Article in English | MEDLINE | ID: covidwho-2264184
ABSTRACT

BACKGROUND:

Up to 48% of ventilated coronavirus disease 2019 (COVID-19) patients develop ventilator-associated pneumonia (VAP) during hospitalization in an ICU. Dysbiotic oral microbiota can colonize the lower respiratory tract and lead to VAP. It is recommended to introduce oral care strategies in the ICU to prevent VAP. In this study, we observed the impact of an oral hygienic protocol with tooth brushing on cultivable oral bacteriota, the incidence of HAI and patient safety among mechanically ventilated COVID-19 patients in an ICU setting.

METHODS:

In this prospective cohort study, we recruited 56 adult COVID-19 patients who qualified for mechanical ventilation. Patients were divided into 2 groups depending on the oral care procedure standard and extended oral procedures with tooth brushing. Oral bacteriota samples were taken first within 36 h and after 7 days of intubation. Microorganisms were identified by MALDI/TOF mass spectrometry. bacterial health care-associated infection (HAI) cases were retrospectively analyzed by etiology. A PFGE study was performed for Klebsiella pneumoniae to check for clonal spreading of strains from oral bacteriota samples and HAI cases.

RESULTS:

We observed significant dysbiosis and a decrease in cultivable oral bacteriota diversity, with a high frequency of potentially pathogenic species, including Acinetobacter baumannii and K. pneumoniae. The HAI incidence rate was high (55.2/1000 patient-days), most commonly of K. pneumoniae and A. baumannii etiologies, which correlated with the presence of A. baumannii and K. pneumoniae in the oral samples. Strains isolated from VAP cases were the same as oral isolates in 8 cases. The procedure with tooth brushing led to less frequent identification of A. baumannii in oral samples (55.6% vs. 5.3%, p = 0.001); however, it did not decrease the incidence of HAIs.

CONCLUSIONS:

Dysbiotic oral bacteriota is an important source of respiratory pathogens. The introduction of tooth brushing in oral hygiene protocols in an ICU setting was effective in decreasing the extent of oral bacteriota dysbiosis; however, it did not reduce the risk of HAIs or mortality. TRIAL REGISTRATION 1072.6120.333.2020.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cross Infection / Pneumonia, Ventilator-Associated / COVID-19 Type of study: Cohort study / Etiology study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Humans Language: English Journal: Antimicrob Resist Infect Control Year: 2023 Document Type: Article Affiliation country: S13756-023-01218-y

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cross Infection / Pneumonia, Ventilator-Associated / COVID-19 Type of study: Cohort study / Etiology study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Humans Language: English Journal: Antimicrob Resist Infect Control Year: 2023 Document Type: Article Affiliation country: S13756-023-01218-y