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Pan J, Zhao J, Jiang N. Oral cavity infection: an adverse effect after the treatment of oral cancer in aged individuals. J Appl Oral Sci 2014; 22:261-7. [PMID: 25141196 PMCID: PMC4126820 DOI: 10.1590/1678-775720130546] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/12/2013] [Indexed: 11/21/2022] Open
Abstract
Objective The immune compromised patients after treatment of oral cancer may have a chance
of infection by drug-resistant opportunistic microbes. We investigated the
occurrence of opportunistic microorganisms in aged individuals receiving follow-up
examinations after treatment of oral cancer in China. Material and Methods These patients were used as test group and the respective age grouped healthy
individuals as control group. In this study, the oral cavity microorganisms such
as bacteria and yeast were taken for the analysis. After the screening of
representative microorganisms, their aptitude of pervasiveness against drugs was
studied. Here, we used antimicrobial agents which are common in clinical practice.
We also performed studies to investigate the presence of toxin genes in
methicillin-resistant S. aureus (MRSA). Results The results indicate that the prevalence of drug-resistant microbes was more
pronounced in oral cancer patients after initial treatment above 70 years old. The
oxacillin resistance of S. aureus isolate confirms that the
prevalence of MRSA is increasing in accordance to age-factor and immune compromise
in elderly patients. Conclusions This study reveals the occurrence of drug-resistant opportunistic microorganisms
in oral cavity after treatment for oral cancer in aged individuals. Special
attention should be directed to MRSA during the treatment of oral cancer, and to
realize the fact of immune compromise in elderly patients.
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Affiliation(s)
- Jie Pan
- Department of Orthodontics, Shanghai Stomatological Disease Centre, Shanghai, China
| | - Jun Zhao
- Department of Orthodontics College of Stomatology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ning Jiang
- Department of Orthodontics College of Stomatology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Lam OLT, McMillan AS, Samaranayake LP, Li LSW, McGrath C. Effect of oral hygiene interventions on opportunistic pathogens in patients after stroke. Am J Infect Control 2013; 41:149-54. [PMID: 22818804 DOI: 10.1016/j.ajic.2012.02.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 02/04/2012] [Accepted: 02/06/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND Despite the role of the oral cavity as a reservoir of opportunistic pathogens for infection in patients following stroke, the evaluation of the effects of oral hygiene interventions has been largely neglected. METHODS This randomized clinical trial included 102 patients undergoing hospital-based rehabilitation for stroke. Patients were randomized to one of 3 groups: oral hygiene instruction (OHI) only; OHI and 0.2% chlorhexidine mouth rinse twice daily; or OHI, 0.2% chlorhexidine mouth rinse twice daily, and assisted brushing twice weekly. Oral samples were obtained at baseline and after 3 weeks for detection of Staphylococcus aureus, aerobic and facultatively anaerobic gram-negative bacilli, and yeasts. RESULTS Almost three-quarters (72.8%) of the patients harbored oral anaerobic gram-negative bacilli at baseline, and more than half had detectable S aureus (56.8%) and yeasts (59.3%). Percentage frequencies and viable counts of pathogens remained relatively stable during the course of the clinical trial, and no significant differences were observed among the 3 patient groups. CONCLUSIONS In our study cohort, there was no significant difference in the effectiveness of the 3 different oral hygiene interventions on the prevalence or viable counts of oral opportunistic pathogens.
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Affiliation(s)
- Otto L T Lam
- Oral Rehabilitation 4/F, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong
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Lam OL, McGrath C, Li LS, Samaranayake LP. Effectiveness of oral hygiene interventions against oral and oropharyngeal reservoirs of aerobic and facultatively anaerobic gram-negative bacilli. Am J Infect Control 2012; 40:175-82. [PMID: 21719150 DOI: 10.1016/j.ajic.2011.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 03/04/2011] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Aerobic and facultatively anaerobic gram-negative bacilli (AGNB) are opportunistic pathogens and continue to cause a large number of hospital-acquired infections. AGNB residing in the oral cavity and oropharynx have been linked to nosocomial pneumonia and septicemia. Although AGNB are not considered members of the normal oral and oropharyngeal flora, medically compromised patients have been demonstrated to be susceptible to AGNB colonization. METHODS A literature search was conducted to retrieve articles that evaluated the effectiveness of oral hygiene interventions in reducing the oral and oropharyngeal carriage of AGNB in medically compromised patients. RESULTS Few studies have documented the use of mechanical oral hygiene interventions alone against AGNB. Although a number of studies have employed oral hygiene interventions complemented by antiseptic agents such as chlorhexidine and povidone iodine, there appears to be a discrepancy between their in vitro and in vivo effectiveness. CONCLUSION With the recognition of the oral cavity and oropharynx as a reservoir of AGNB and the recent emergence of multidrug and pandrug resistance in hospital settings, there is a pressing need for additional high-quality randomized controlled trials to determine which oral hygiene interventions or combination of interventions are most effective in eliminating or reducing AGNB carriage.
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Abstract
The oral cavity of the hospitalized or bedridden elderly is often a reservoir for opportunistic pathogens associated with respiratory diseases. Commensal flora and the host interact in a balanced fashion and oral infections are considered to appear following an imbalance in the oral resident microbiota, leading to the emergence of potentially pathogenic bacteria. The definition of the process involved in colonization by opportunistic respiratory pathogens needs to elucidate the factors responsible for the transition of the microbiota from commensal to pathogenic flora. The regulatory factors influencing the oral ecosystem can be divided into three major categories: the host defense system, commensal bacteria, and external pathogens. In this article, we review the profile of these categories including the intricate cellular interaction between immune factors and commensal bacteria and the disturbance in homeostasis in the oral cavity of hospitalized or bedridden elderly, which facilitates oral colonization by opportunistic respiratory pathogens.
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Affiliation(s)
- Akio Tada
- Department of Oral Health, National Institute of Public Health, Wako, Saitama, Japan.
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Seppänen L, Rautemaa R, Lindqvist C, Lauhio A. Changing clinical features of odontogenic maxillofacial infections. Clin Oral Investig 2009; 14:459-65. [PMID: 19449042 DOI: 10.1007/s00784-009-0281-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 04/30/2009] [Indexed: 10/20/2022]
Abstract
Odontogenic maxillofacial infections occasionally require hospital care. Our aim was to study whether the number and the clinical features of patients hospitalized due to odontogenic abscesses in a large hospital district in Finland had changed in one decade. A retrospective analysis of two 12-month study cohorts one decade apart from the same population base was conducted. The first cohort comprised 71 patients and the second cohort comprised 101 patients. The incidence of odontogenic infections requiring hospital care increased from 5.3 to 7.2 per 100,000 inhabitants. The need for intensive care increased significantly from 15% to 32%, and the maximal C-reactive protein levels were significantly higher in the latter cohort, 127 mg/L, compared to the first cohort, 104 mg/L. The proportion of previously healthy patients decreased significantly from 83% to 65%. Odontogenic maxillofacial infections have become more prevalent and more severe during the decade in our hospital district. An increasing proportion of patients had underlying diseases.
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Affiliation(s)
- Lotta Seppänen
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, PO Box 21 Haartmaninkatu 3, Helsinki 00014, Finland
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Seppänen L, Lauhio A, Lindqvist C, Suuronen R, Rautemaa R. Analysis of systemic and local odontogenic infection complications requiring hospital care. J Infect 2008; 57:116-22. [PMID: 18649947 DOI: 10.1016/j.jinf.2008.06.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Revised: 05/30/2008] [Accepted: 06/02/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Analysis of systemic and local odontogenic infection complications requiring hospital care. METHODS All cases of odontogenic infections requiring hospital care, which were adjudicated in the Finnish Patient Insurance Centre during 2000-2003, were analysed. Patient characteristics, and the course and outcome of infection were reviewed. RESULTS The study material consisted of 35 patient cases; 15 male, 20 female; mean age 38.4 (16-67) years. The mean length of hospital stay was 14.8 (2-81) days. Nine patients required intensive care for mean 6.2 (2-19) days. Twenty-five (71%) patients developed local infection complications with cellulitis and abscess formation, and 10 (29%) patients a generalised or metastatic infection complication. The length of hospital stay among patients with systemic complications was longer than with local complications, 30.2 (2-81) days vs. 8.0 (2-34) days (p=0.0144). All patients with local complications survived but three of the 10 patients with systemic complications died. Medically compromised patients with underlying disease developed more often systemic infection complications than previously healthy patients (p=0.0028). CONCLUSIONS Medically compromised patients appear more susceptible to systemic rather than local infection complications with a need for significantly longer hospital stay and with an increased risk for fatal complications.
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Affiliation(s)
- Lotta Seppänen
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, FIN-00014 Helsinki, Finland
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Dos Santos Moraes F, Antonio AG, Almeida MLPW, de Almeida Lima Castro R, Vianna R. Pseudomonas aeruginosa in the Early Childhood: A Case Report. Clin Med Case Rep 2008; 1:25-8. [PMID: 24179340 PMCID: PMC3785349 DOI: 10.4137/ccrep.s713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pseudomonas aeruginosa is an opportunistic bacterium that usually affects immunocompromised patients, causing infections whose signals and symptoms are related to the affected organ. The patient presented in this article was infected when he was 9 months old. Such condition led to certain alterations like dental improperly positioned teeth, retained deciduous teeth, hipodonty of permanent teeth, atrophy of the upper jaw and dental crowding. Therefore, the purpose of this article is to report the case of a patient affected by Pseudomonas aeruginosa infection in the early childhood and to describe the dental development disorders as consequence of this fact.
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Tada A, Senpuku H, Motozawa Y, Yoshihara A, Hanada N, Tanzawa H. Association between commensal bacteria and opportunistic pathogens in the dental plaque of elderly individuals. Clin Microbiol Infect 2006; 12:776-81. [PMID: 16842573 DOI: 10.1111/j.1469-0691.2006.01497.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Opportunistic infections in the oral cavity of the elderly may increase the incidence of systemic disease. The objective of this study was to investigate the differences in the oral bacterial flora between dependent elderly (inpatients) and independent elderly (community-dwelling residents). After multiple variables were taken into account, inpatients had significantly lower detection rates than community-dwelling residents for alpha-streptococci (p < 0.001) and Neisseria (p 0.004), and higher detection rates for Pseudomonas aeruginosa (p 0.024), methicillin-resistant Staphylococcus aureus (MRSA) (p 0.011) and Actinomyces spp. (p 0.005). Among inpatients, the requirement for a high degree of care was related negatively to detection of alpha-streptococci, but was related significantly to detection of P. aeruginosa (p 0.018) or MRSA (p 0.004). Tube-fed inpatients had a significantly lower detection rate for alpha-streptococci (p 0.041) and a higher detection rate for P. aeruginosa (p 0.004) than those who did not require tube feeding. Inpatients with a history of antibiotic use had a significantly lower detection rate for alpha-streptococci (p 0.049) and a higher detection rate for MRSA (p 0.007) than those without a history of antibiotic use. The detection rates for P. aeruginosa or MRSA in inpatients without alpha-streptococci were higher than in inpatients with alpha-streptococci after controlling for age and gender (P. aeruginosa, p 0.006; MRSA, p 0.001). Overall, detection of alpha-streptococci had an inverse correlation with the detection of P. aeruginosa and MRSA in the oral cavity and is likely to be an indicator of pathogenic bacterial infection.
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Affiliation(s)
- A Tada
- Chiba City Health Center, Chiba, Japan
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Gosney MA, Martin MV, Wright AE, Gallagher M. Enterobacter sakazakii in the mouths of stroke patients and its association with aspiration pneumonia. Eur J Intern Med 2006; 17:185-8. [PMID: 16618451 DOI: 10.1016/j.ejim.2005.11.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Revised: 11/10/2005] [Accepted: 11/15/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies by our group have identified a high prevalence of Gram-negative bacilli in the mouths of stroke patients. Eradication of such organisms by selective decontamination of the digestive tract (SDD) has not previously been studied. Enterobacter sakazakii is a rarely found organism that has previously been identified as a cause of neonatal meningitis and sepsis but that has rarely been reported as a pathogen in older people. The purpose of this study was to look specifically for E. sakazakii in the mouths of stroke patients and to correlate its isolation with response to SDD gel and the presence of clinical complications such as pneumonia. METHODS Following an acute stroke, 203 patients were recruited for the study and received placebo or SDD in a 50:50 ratio. Oral swabs were obtained on nine separate occasions and E. sakazakii was cultured from them. Clinical data were prospectively collected and analysed. RESULTS E. sakazakii was identified in 7 of 203 patients. The organism was almost exclusively removed by SDD gel, but in those patients in whom an abnormal swallow was present, pneumonia was found in two of the four cases. CONCLUSION E. sakazakii may colonise the mouths of acute stroke patients. Since SDD gel is not routinely administered to such patients, this organism may be implicated in patients who subsequently develop aspiration pneumonia.
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Affiliation(s)
- Margot A Gosney
- Elderly Care Medicine, The University of Reading, Institute of Health Sciences, London Road, Reading, Berkshire RG1 5AQ, UK
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Senpuku H, Tada A, Uehara S, Kariyama R, Kumon H. Post-operative infection by pathogenic micro-organisms in the oral cavity of patients with prostatic carcinoma. J Int Med Res 2006; 34:95-102. [PMID: 16604829 DOI: 10.1177/147323000603400112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The aim of this study was to analyse the change in the oral cavity microflora of 14 patients who had undergone a radical prostatectomy for prostatic carcinoma. The detection of micro-organisms in the oral cavity was compared before and after the surgical procedure. Post-operative infection, defined as those patients who had increased Candida species counts and/or pathogenic bacteria only at the post-operative examination, was observed in 10 patients. Six patients showed increased Candida species counts at the post-operative examination compared with the pre-operative examination. In five patients, pathogenic bacterial species were detected at the post-operative examination but not at the pre-operative examination. One patient had detectable pathogenic bacterial species only at the post-operative examination along with increased Candida species counts. Our findings suggest that pre-operative oral hygiene to remove bacterial and Candida species from patients who are scheduled for surgical procedures is important for satisfactory clinical outcomes.
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Affiliation(s)
- H Senpuku
- Department of Bacteriology, National Institute of Infectious Diseases, Tokyo, Japan.
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Seymour RA, Whitworth JM, Martin M. Antibiotic prophylaxis for patients with joint prostheses - still a dilemma for dental practitioners. Br Dent J 2003; 194:649-53. [PMID: 12830173 DOI: 10.1038/sj.bdj.4810352] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2002] [Accepted: 12/03/2002] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To provide a critical review of the current evidence that implicates dental-induced bacteraemia as a risk for joint infections in patients fitted with joint prostheses and appraise the need for antibiotic prophylaxis. DESIGN Retrospective analysis. SETTING Mainly hospital-based patients or subjects. OUTCOME MEASURES The relationship between joint infections and dental treatment is equivocal at the best and there is no evidence that antibiotic prophylaxis provides such patients with any protection. RESULTS Microbiological evidence linking dental treatment-induced bacteraemia to joint infections is weak and if an oral commensal is implicated, it is more likely to have arisen either from a spontaneous bacteraemia or from a dental infection. As a consequence of the latter, we recommended the institution of good dental health prior to joint replacement. There may be a case for providing prophylaxis to the immuno-compromised patient, but only if the immuno-suppression is associated with a neutropenia. In such circumstances, only emergency treatment should be considered until the neutropenia is resolved. Antibiotic regimens that are recommended by orthopaedic surgeons have not been evaluated in a randomised placebo-controlled study and many of the drugs are not licensed for this purpose. The evidence on cost-risk benefit seems to demonstrate that antibiotic prophylaxis with either amoxicillin or penicillin is not cost effective when compared with no prophylaxis. CONCLUSION The case for providing antibiotic prophylaxis prior to dental treatment in patients fitted with a joint prosthesis is weak or virtually non-existent. Furthermore, the risk from providing prophylaxis is greater than the risk of a joint infection.
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Affiliation(s)
- R A Seymour
- Department of Restorative Dentistry, School of Dental Sciences, University of Newcastle upon Tyne, Framlington Place, NE2 4BW.
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