Dental and Microbiological Risk Factors for Hospital-Acquired Pneumonia in Non-Ventilated Older Patients
Identifieur interne : 001264 ( Main/Exploration ); précédent : 001263; suivant : 001265Dental and Microbiological Risk Factors for Hospital-Acquired Pneumonia in Non-Ventilated Older Patients
Auteurs : Victoria C. Ewan [Royaume-Uni] ; Andrew D. Sails [Royaume-Uni] ; Angus W. G. Walls [États-Unis] ; Steven Rushton [Royaume-Uni] ; Julia L. Newton [Royaume-Uni]Source :
- PLoS ONE [ 1932-6203 ] ; 2015.
Abstract
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.
We 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
The 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
Patients with lower limb fracture who were colonised orally with
Url:
DOI: 10.1371/journal.pone.0123622
PubMed: 25923662
PubMed Central: 4414413
Affiliations:
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Sails</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Public Health England, Microbiology Services, Newcastle Laboratory, Newcastle upon Tyne, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Public Health England, Microbiology Services, Newcastle Laboratory, Newcastle upon Tyne</wicri:regionArea><wicri:noRegion>Newcastle upon Tyne</wicri:noRegion></affiliation></author><author><name sortKey="Walls, Angus W G" sort="Walls, Angus W G" uniqKey="Walls A" first="Angus W. G." last="Walls">Angus W. G. Walls</name><affiliation wicri:level="4"><nlm:aff id="aff003"><addr-line>Edinburgh Dental Institute, University of Edinburgh, Edinburgh, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Edinburgh Dental Institute, University of Edinburgh, Edinburgh</wicri:regionArea><placeName><settlement type="city">Édimbourg</settlement><region type="country">Écosse</region><settlement type="city">Édimbourg</settlement></placeName><orgName type="university">Université d'Édimbourg</orgName></affiliation></author><author><name sortKey="Rushton, Steven" sort="Rushton, Steven" uniqKey="Rushton S" first="Steven" last="Rushton">Steven Rushton</name><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>Biological Modelling, Newcastle University, Newcastle upon Tyne, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Biological Modelling, Newcastle University, Newcastle upon Tyne</wicri:regionArea><wicri:noRegion>Newcastle upon Tyne</wicri:noRegion></affiliation></author><author><name sortKey="Newton, Julia L" sort="Newton, Julia L" uniqKey="Newton J" first="Julia L." last="Newton">Julia L. Newton</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Newcastle University Institute for Ageing, Newcastle upon Tyne, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Newcastle University Institute for Ageing, Newcastle upon Tyne</wicri:regionArea><wicri:noRegion>Newcastle upon Tyne</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25923662</idno><idno type="pmc">4414413</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414413</idno><idno type="RBID">PMC:4414413</idno><idno type="doi">10.1371/journal.pone.0123622</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000415</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000415</idno><idno type="wicri:Area/Pmc/Curation">000415</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000415</idno><idno type="wicri:Area/Pmc/Checkpoint">000E95</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000E95</idno><idno type="wicri:Area/Ncbi/Merge">005A91</idno><idno type="wicri:Area/Ncbi/Curation">005A91</idno><idno type="wicri:Area/Ncbi/Checkpoint">005A91</idno><idno type="wicri:Area/Main/Merge">001267</idno><idno type="wicri:Area/Main/Curation">001264</idno><idno type="wicri:Area/Main/Exploration">001264</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Dental and Microbiological Risk Factors for Hospital-Acquired Pneumonia in Non-Ventilated Older Patients</title><author><name sortKey="Ewan, Victoria C" sort="Ewan, Victoria C" uniqKey="Ewan V" first="Victoria C." last="Ewan">Victoria C. Ewan</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Newcastle University Institute for Ageing, Newcastle upon Tyne, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Newcastle University Institute for Ageing, Newcastle upon Tyne</wicri:regionArea><wicri:noRegion>Newcastle upon Tyne</wicri:noRegion></affiliation></author><author><name sortKey="Sails, Andrew D" sort="Sails, Andrew D" uniqKey="Sails A" first="Andrew D." last="Sails">Andrew D. Sails</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Public Health England, Microbiology Services, Newcastle Laboratory, Newcastle upon Tyne, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Public Health England, Microbiology Services, Newcastle Laboratory, Newcastle upon Tyne</wicri:regionArea><wicri:noRegion>Newcastle upon Tyne</wicri:noRegion></affiliation></author><author><name sortKey="Walls, Angus W G" sort="Walls, Angus W G" uniqKey="Walls A" first="Angus W. G." last="Walls">Angus W. G. Walls</name><affiliation wicri:level="4"><nlm:aff id="aff003"><addr-line>Edinburgh Dental Institute, University of Edinburgh, Edinburgh, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Edinburgh Dental Institute, University of Edinburgh, Edinburgh</wicri:regionArea><placeName><settlement type="city">Édimbourg</settlement><region type="country">Écosse</region><settlement type="city">Édimbourg</settlement></placeName><orgName type="university">Université d'Édimbourg</orgName></affiliation></author><author><name sortKey="Rushton, Steven" sort="Rushton, Steven" uniqKey="Rushton S" first="Steven" last="Rushton">Steven Rushton</name><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>Biological Modelling, Newcastle University, Newcastle upon Tyne, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Biological Modelling, Newcastle University, Newcastle upon Tyne</wicri:regionArea><wicri:noRegion>Newcastle upon Tyne</wicri:noRegion></affiliation></author><author><name sortKey="Newton, Julia L" sort="Newton, Julia L" uniqKey="Newton J" first="Julia L." last="Newton">Julia L. Newton</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Newcastle University Institute for Ageing, Newcastle upon Tyne, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Newcastle University Institute for Ageing, Newcastle upon Tyne</wicri:regionArea><wicri:noRegion>Newcastle upon Tyne</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>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.</p><sec id="sec001"><title>Methods</title><p>We 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 <italic>S</italic>. <italic>aureus</italic>, MRSA, <italic>E</italic>. <italic>coli</italic>, <italic>P</italic>. <italic>aeruginosa</italic>, <italic>S</italic>. <italic>pneumoniae</italic>, <italic>H</italic>. <italic>influenza</italic> and <italic>Acinetobacter</italic> spp. We collected data on dental/denture plaque (modified Quigley-Hein index) and outcomes of clinician-diagnosed HAP.</p></sec><sec id="sec002"><title>Results</title><p>The 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 <italic>E</italic>. <italic>coli/S</italic>. <italic>aureus/P</italic>.<italic>aeruginosa</italic>/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 <italic>S</italic>. <italic>aureus</italic>/MRSA/<italic>P</italic>. <italic>aeruginosa/E</italic>. <italic>coli</italic> being detected at days 5 (OR 4.39, 95%CI1.73-11.16) or 14 (OR 6.69, 95%CI 2.40-18.60).</p></sec><sec id="sec003"><title>Conclusions</title><p>Patients with lower limb fracture who were colonised orally with <italic>E</italic>. <italic>coli/ S</italic>. <italic>aureus</italic>/MRSA/<italic>P</italic>. <italic>aeruginosa</italic> after 5 days in hospital were at significantly greater risk of HAP (p = 0.002).</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Roche, Jjw" uniqKey="Roche J">JJW Roche</name></author><author><name sortKey="Wenn, Rt" uniqKey="Wenn R">RT Wenn</name></author><author><name sortKey="Sahota, O" uniqKey="Sahota O">O 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uniqKey="Kerslake D">D Kerslake</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lieberman, D" uniqKey="Lieberman D">D Lieberman</name></author><author><name sortKey="Shleyfer, E" uniqKey="Shleyfer E">E Shleyfer</name></author><author><name sortKey="Castel, H" uniqKey="Castel H">H Castel</name></author><author><name sortKey="Terry, A" uniqKey="Terry A">A Terry</name></author><author><name sortKey="Harman Boehm, I" uniqKey="Harman Boehm I">I Harman-Boehm</name></author><author><name sortKey="Delgado, J" uniqKey="Delgado J">J Delgado</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Écosse</li></region><settlement><li>Édimbourg</li></settlement><orgName><li>Université d'Édimbourg</li></orgName></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Ewan, Victoria C" sort="Ewan, Victoria C" uniqKey="Ewan V" first="Victoria C." last="Ewan">Victoria C. Ewan</name></noRegion><name sortKey="Newton, Julia L" sort="Newton, Julia L" uniqKey="Newton J" first="Julia L." last="Newton">Julia L. Newton</name><name sortKey="Rushton, Steven" sort="Rushton, Steven" uniqKey="Rushton S" first="Steven" last="Rushton">Steven Rushton</name><name sortKey="Sails, Andrew D" sort="Sails, Andrew D" uniqKey="Sails A" first="Andrew D." last="Sails">Andrew D. Sails</name></country><country name="États-Unis"><region name="Écosse"><name sortKey="Walls, Angus W G" sort="Walls, Angus W G" uniqKey="Walls A" first="Angus W. G." last="Walls">Angus W. G. Walls</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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