Changes in dental plaque following hospitalisation in a critical care unit: an observational study
Identifieur interne : 004958 ( Ncbi/Checkpoint ); précédent : 004957; suivant : 004959Changes in dental plaque following hospitalisation in a critical care unit: an observational study
Auteurs : Mishal Sachdev [Royaume-Uni] ; Derren Ready [Royaume-Uni] ; David Brealey [Royaume-Uni] ; Jung Hyun Ryu [Royaume-Uni] ; Georgia Bercades [Royaume-Uni] ; Janette Nagle [Royaume-Uni] ; Susana Borja-Boluda [Royaume-Uni] ; Elisa Agudo [Royaume-Uni] ; Aviva Petrie [Royaume-Uni] ; Jean Suvan [Royaume-Uni] ; Nikos Donos [Royaume-Uni] ; Mervyn Singer [Royaume-Uni] ; Ian Needleman [Royaume-Uni]Source :
- Critical Care [ 1364-8535 ] ; 2013.
Abstract
Previous research has suggested that deterioration in oral health can occur following hospitalisation. The impact of such deterioration could increase the risk of oral disease, reduce quality of life and increase the potential for healthcare-associated infections (HCAI) such as healthcare-associated pneumonia (HAP). However, the strength of the evidence is limited by, amongst other factors, the few observational studies published that assess oral health longitudinally. In view of the microbiological component of oral diseases and HCAIs, the objective of this study was to investigate the microbiological changes in dental plaque following hospitalisation in a Critical Care Unit (CCU): (1) total number of cultivable bacteria and (2) presence and changes in specific HAP pathogens.
We conducted a prospective, longitudinal observational study in the CCU of University College Hospital, London. Study participants were recruited within 24 hours of admission. Dental plaque samples were collected from up to six sites per patient. The primary outcome was microbiological change from baseline to seven days with additional analysis for participants still present at day 14.
50 patients were recruited with 36 available for review at one week, with early discharge accounting for much of the loss to follow-up. The median total viable count of the plaque microbiota at baseline was 4.40 × 105 cfu/ml and increased at week one to 3.44 × 106 cfu/ml. The total viable microbe counts increased by a median of 2.26 × 106 cfu/ml from baseline to week one (95% CI: 3.19 × 106, 1.24 × 107) and this was statistically significant (
Total bacterial count of dental plaque increases during hospitalisation in CCU. This finding, together with the colonisation of dental plaque by HAP bacteria strengthens the evidence for a deterioration in oral health in CCU and a risk factor for negative health and quality of life outcomes.
Url:
DOI: 10.1186/cc12878
PubMed: 24007571
PubMed Central: 4055983
Affiliations:
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Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>UCLH Bloomsbury Institute of Intensive Care Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU</wicri:regionArea><wicri:noRegion>NW1 2BU</wicri:noRegion></affiliation></author><author><name sortKey="Agudo, Elisa" sort="Agudo, Elisa" uniqKey="Agudo E" first="Elisa" last="Agudo">Elisa Agudo</name><affiliation wicri:level="1"><nlm:aff id="I1">Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD</wicri:regionArea><wicri:noRegion>London WC1X 8LD</wicri:noRegion></affiliation></author><author><name sortKey="Petrie, Aviva" sort="Petrie, Aviva" uniqKey="Petrie A" first="Aviva" last="Petrie">Aviva Petrie</name><affiliation wicri:level="1"><nlm:aff id="I4">Biostatistics Unit, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Biostatistics Unit, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD</wicri:regionArea><wicri:noRegion>London WC1X 8LD</wicri:noRegion></affiliation></author><author><name sortKey="Suvan, Jean" sort="Suvan, Jean" uniqKey="Suvan J" first="Jean" last="Suvan">Jean Suvan</name><affiliation wicri:level="1"><nlm:aff id="I1">Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD</wicri:regionArea><wicri:noRegion>London WC1X 8LD</wicri:noRegion></affiliation></author><author><name sortKey="Donos, Nikos" sort="Donos, Nikos" uniqKey="Donos N" first="Nikos" last="Donos">Nikos Donos</name><affiliation wicri:level="1"><nlm:aff id="I1">Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD</wicri:regionArea><wicri:noRegion>London WC1X 8LD</wicri:noRegion></affiliation></author><author><name sortKey="Singer, Mervyn" sort="Singer, Mervyn" uniqKey="Singer M" first="Mervyn" last="Singer">Mervyn Singer</name><affiliation wicri:level="1"><nlm:aff id="I3">UCLH Bloomsbury Institute of Intensive Care Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>UCLH Bloomsbury Institute of Intensive Care Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU</wicri:regionArea><wicri:noRegion>NW1 2BU</wicri:noRegion></affiliation></author><author><name sortKey="Needleman, Ian" sort="Needleman, Ian" uniqKey="Needleman I" first="Ian" last="Needleman">Ian Needleman</name><affiliation wicri:level="1"><nlm:aff id="I1">Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD</wicri:regionArea><wicri:noRegion>London WC1X 8LD</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno 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study</title><author><name sortKey="Sachdev, Mishal" sort="Sachdev, Mishal" uniqKey="Sachdev M" first="Mishal" last="Sachdev">Mishal Sachdev</name><affiliation wicri:level="1"><nlm:aff id="I1">Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD</wicri:regionArea><wicri:noRegion>London WC1X 8LD</wicri:noRegion></affiliation></author><author><name sortKey="Ready, Derren" sort="Ready, Derren" uniqKey="Ready D" first="Derren" last="Ready">Derren Ready</name><affiliation wicri:level="1"><nlm:aff id="I2">HPA, London Public Health Laboratory, Barts Health NHS Trust, Department of Infection, 3rd Floor Pathology & Pharmacy Building, 80 Newark Street, London E1 2ES, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>HPA, London Public Health Laboratory, Barts Health NHS Trust, Department of Infection, 3rd Floor Pathology & Pharmacy Building, 80 Newark Street, London E1 2ES</wicri:regionArea><wicri:noRegion>London E1 2ES</wicri:noRegion></affiliation></author><author><name sortKey="Brealey, David" sort="Brealey, David" uniqKey="Brealey D" first="David" last="Brealey">David Brealey</name><affiliation wicri:level="1"><nlm:aff id="I3">UCLH Bloomsbury Institute of Intensive Care Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>UCLH Bloomsbury Institute of Intensive Care Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU</wicri:regionArea><wicri:noRegion>NW1 2BU</wicri:noRegion></affiliation></author><author><name sortKey="Ryu, Jung Hyun" sort="Ryu, Jung Hyun" uniqKey="Ryu J" first="Jung Hyun" last="Ryu">Jung Hyun Ryu</name><affiliation wicri:level="1"><nlm:aff id="I3">UCLH Bloomsbury Institute of Intensive Care Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>UCLH Bloomsbury Institute of Intensive Care Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU</wicri:regionArea><wicri:noRegion>NW1 2BU</wicri:noRegion></affiliation></author><author><name sortKey="Bercades, Georgia" sort="Bercades, Georgia" uniqKey="Bercades G" first="Georgia" last="Bercades">Georgia Bercades</name><affiliation wicri:level="1"><nlm:aff id="I3">UCLH Bloomsbury Institute of Intensive Care Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>UCLH Bloomsbury Institute of Intensive Care Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU</wicri:regionArea><wicri:noRegion>NW1 2BU</wicri:noRegion></affiliation></author><author><name sortKey="Nagle, Janette" sort="Nagle, Janette" uniqKey="Nagle J" first="Janette" last="Nagle">Janette Nagle</name><affiliation wicri:level="1"><nlm:aff id="I3">UCLH Bloomsbury Institute of Intensive Care Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>UCLH Bloomsbury Institute of Intensive Care Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU</wicri:regionArea><wicri:noRegion>NW1 2BU</wicri:noRegion></affiliation></author><author><name sortKey="Borja Boluda, Susana" sort="Borja Boluda, Susana" uniqKey="Borja Boluda S" first="Susana" last="Borja-Boluda">Susana Borja-Boluda</name><affiliation wicri:level="1"><nlm:aff id="I3">UCLH Bloomsbury Institute of Intensive Care Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>UCLH Bloomsbury Institute of Intensive Care Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU</wicri:regionArea><wicri:noRegion>NW1 2BU</wicri:noRegion></affiliation></author><author><name sortKey="Agudo, Elisa" sort="Agudo, Elisa" uniqKey="Agudo E" first="Elisa" last="Agudo">Elisa Agudo</name><affiliation wicri:level="1"><nlm:aff id="I1">Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD</wicri:regionArea><wicri:noRegion>London WC1X 8LD</wicri:noRegion></affiliation></author><author><name sortKey="Petrie, Aviva" sort="Petrie, Aviva" uniqKey="Petrie A" first="Aviva" last="Petrie">Aviva Petrie</name><affiliation wicri:level="1"><nlm:aff id="I4">Biostatistics Unit, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Biostatistics Unit, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD</wicri:regionArea><wicri:noRegion>London WC1X 8LD</wicri:noRegion></affiliation></author><author><name sortKey="Suvan, Jean" sort="Suvan, Jean" uniqKey="Suvan J" first="Jean" last="Suvan">Jean Suvan</name><affiliation wicri:level="1"><nlm:aff id="I1">Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD</wicri:regionArea><wicri:noRegion>London WC1X 8LD</wicri:noRegion></affiliation></author><author><name sortKey="Donos, Nikos" sort="Donos, Nikos" uniqKey="Donos N" first="Nikos" last="Donos">Nikos Donos</name><affiliation wicri:level="1"><nlm:aff id="I1">Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD</wicri:regionArea><wicri:noRegion>London WC1X 8LD</wicri:noRegion></affiliation></author><author><name sortKey="Singer, Mervyn" sort="Singer, Mervyn" uniqKey="Singer M" first="Mervyn" last="Singer">Mervyn Singer</name><affiliation wicri:level="1"><nlm:aff id="I3">UCLH Bloomsbury Institute of Intensive Care Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>UCLH Bloomsbury Institute of Intensive Care Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU</wicri:regionArea><wicri:noRegion>NW1 2BU</wicri:noRegion></affiliation></author><author><name sortKey="Needleman, Ian" sort="Needleman, Ian" uniqKey="Needleman I" first="Ian" last="Needleman">Ian Needleman</name><affiliation wicri:level="1"><nlm:aff id="I1">Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD</wicri:regionArea><wicri:noRegion>London WC1X 8LD</wicri:noRegion></affiliation></author></analytic><series><title level="j">Critical Care</title><idno type="ISSN">1364-8535</idno><idno type="eISSN">1466-609X</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>Previous research has suggested that deterioration in oral health can occur following hospitalisation. The impact of such deterioration could increase the risk of oral disease, reduce quality of life and increase the potential for healthcare-associated infections (HCAI) such as healthcare-associated pneumonia (HAP). However, the strength of the evidence is limited by, amongst other factors, the few observational studies published that assess oral health longitudinally. In view of the microbiological component of oral diseases and HCAIs, the objective of this study was to investigate the microbiological changes in dental plaque following hospitalisation in a Critical Care Unit (CCU): (1) total number of cultivable bacteria and (2) presence and changes in specific HAP pathogens.</p></sec><sec><title>Methods</title><p>We conducted a prospective, longitudinal observational study in the CCU of University College Hospital, London. Study participants were recruited within 24 hours of admission. Dental plaque samples were collected from up to six sites per patient. The primary outcome was microbiological change from baseline to seven days with additional analysis for participants still present at day 14.</p></sec><sec><title>Results</title><p>50 patients were recruited with 36 available for review at one week, with early discharge accounting for much of the loss to follow-up. The median total viable count of the plaque microbiota at baseline was 4.40 × 10<sup>5 </sup>cfu/ml and increased at week one to 3.44 × 10<sup>6 </sup>cfu/ml. The total viable microbe counts increased by a median of 2.26 × 10<sup>6 </sup>cfu/ml from baseline to week one (95% CI: 3.19 × 10<sup>6</sup>, 1.24 × 10<sup>7</sup>) and this was statistically significant (<italic>P </italic>< 0.01). Specific HAP bacteria were detected in 26% of participants sampled, although accounted for a relatively low proportion of the total viable bacteria.</p></sec><sec><title>Conclusion</title><p>Total bacterial count of dental plaque increases during hospitalisation in CCU. This finding, together with the colonisation of dental plaque by HAP bacteria strengthens the evidence for a deterioration in oral health in CCU and a risk factor for negative health and quality of life outcomes.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Terezakis, E" uniqKey="Terezakis E">E Terezakis</name></author><author><name sortKey="Needleman, I" uniqKey="Needleman I">I Needleman</name></author><author><name sortKey="Kumar, N" uniqKey="Kumar N">N Kumar</name></author><author><name sortKey="Moles, D" uniqKey="Moles D">D Moles</name></author><author><name sortKey="Agudo, E" uniqKey="Agudo E">E Agudo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tonetti, Ms" uniqKey="Tonetti M">MS Tonetti</name></author><author><name sortKey="D Aiuto, F" uniqKey="D Aiuto F">F D'Aiuto</name></author><author><name sortKey="Nibali, L" uniqKey="Nibali L">L Nibali</name></author><author><name 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sortKey="Duke, Rl" uniqKey="Duke R">RL Duke</name></author><author><name sortKey="Campbell, Bh" uniqKey="Campbell B">BH Campbell</name></author><author><name sortKey="Indresano, At" uniqKey="Indresano A">AT Indresano</name></author><author><name sortKey="Eaton, Dj" uniqKey="Eaton D">DJ Eaton</name></author><author><name sortKey="Marbella, Am" uniqKey="Marbella A">AM Marbella</name></author><author><name sortKey="Myers, Kb" uniqKey="Myers K">KB Myers</name></author><author><name sortKey="Layde, Pm" uniqKey="Layde P">PM Layde</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Royaume-Uni</li></country></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Sachdev, Mishal" sort="Sachdev, Mishal" uniqKey="Sachdev M" first="Mishal" last="Sachdev">Mishal Sachdev</name></noRegion><name sortKey="Agudo, Elisa" sort="Agudo, Elisa" uniqKey="Agudo E" first="Elisa" last="Agudo">Elisa Agudo</name><name sortKey="Bercades, Georgia" sort="Bercades, Georgia" uniqKey="Bercades G" first="Georgia" last="Bercades">Georgia Bercades</name><name sortKey="Borja Boluda, Susana" sort="Borja Boluda, Susana" uniqKey="Borja Boluda S" first="Susana" last="Borja-Boluda">Susana Borja-Boluda</name><name sortKey="Brealey, David" sort="Brealey, David" uniqKey="Brealey D" first="David" last="Brealey">David Brealey</name><name sortKey="Donos, Nikos" sort="Donos, Nikos" uniqKey="Donos N" first="Nikos" last="Donos">Nikos Donos</name><name sortKey="Nagle, Janette" sort="Nagle, Janette" uniqKey="Nagle J" first="Janette" last="Nagle">Janette Nagle</name><name sortKey="Needleman, Ian" sort="Needleman, Ian" uniqKey="Needleman I" first="Ian" last="Needleman">Ian Needleman</name><name sortKey="Petrie, Aviva" sort="Petrie, Aviva" uniqKey="Petrie A" first="Aviva" last="Petrie">Aviva Petrie</name><name sortKey="Ready, Derren" sort="Ready, Derren" uniqKey="Ready D" first="Derren" last="Ready">Derren Ready</name><name sortKey="Ryu, Jung Hyun" sort="Ryu, Jung Hyun" uniqKey="Ryu J" first="Jung Hyun" last="Ryu">Jung Hyun Ryu</name><name sortKey="Singer, Mervyn" sort="Singer, Mervyn" uniqKey="Singer M" first="Mervyn" last="Singer">Mervyn Singer</name><name sortKey="Suvan, Jean" sort="Suvan, Jean" uniqKey="Suvan J" first="Jean" last="Suvan">Jean Suvan</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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