Impact of tooth brushing on oral bacteriota and health care-associated infections among ventilated COVID-19 patients: an intervention study

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.

Oral Myco- and Bacteriobiota and Yeast Infections in Mechanically Ventilated COVID-19 Patients

“…colonization and qualitative shifts towards higher identification rate of non-albicans Candida species [ 38 ]. Previous studies showed significant alarming dysbiosis of oral bacteriota in such populations [ 18 ], with high rates of healthcare-acquired infections of Acinetobacter baumannii, Enterococcus faecalis, Escherichia coli, and Klebsiella pneumoniae etiology [ 13 ]. Poor oral health status, high frequency of oral colonization by potentially pathogenic bacteria and early postintubation dysbiosis may also play a significant role in the development of candidiasis [ 13 ].…”

“…During the observation, patients received two types of oral care—the standard procedure that included cleaning, moisturizing of oral cavity and suction of excess fluid or the extended procedure with additional tooth brushing. The detailed description of the intervention and its effects on oral bacteriobiota has been published elsewhere [ 13 ].…”

“…The bacterial cultures and results were described in detail earlier [ 13 , 16 ]. After incubation, colonies were counted, reported, and assessed phenotypically.…”

“…In individuals with comorbidities or with compromised immune systems, the risk of severe forms of COVID-19, including acute respiratory distress syndrome (ARDS), is higher [ 11 ]. Such critically ill COVID-19 patients, when admitted to the intensive care unit (ICU) and requiring mechanical ventilation, are more likely to develop healthcare-associated infections [ 12 , 13 ]. Cases of both bacterial and fungal infections were reported, with studies focusing on multidrug resistant bacterial strains, mucormycosis, and aspergillosis [ 12 , 14 , 15 , 16 ].…”

Nosokomiale Pneumonien – Teil 2: Präventionsmaßnahmen

“…Bei sehr schlechtem Dentalzustand (massiver Zahnstein, Entzündungen, tiefe Zahntaschen usw.) ist eine zahnärztliche Konsultation zu erwägen[9,10]. Die Zahn-und Mundpflege sollte mindestens 2-mal täglich durchgeführt werden.…”