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Guillamet CV, Kollef MH. Is Zero Ventilator-Associated Pneumonia Achievable? Updated Practical Approaches to Ventilator-Associated Pneumonia Prevention. Infect Dis Clin North Am 2024; 38:65-86. [PMID: 38040518 DOI: 10.1016/j.idc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Ventilator-associated pneumonia (VAP) remains a significant clinical entity with reported incidence rates of 7% to 15%. Given the considerable adverse consequences associated with this infection, VAP prevention became a core measure required in most US hospitals. Many institutions took pride in implementing effective VAP prevention bundles that combined at least head of bed elevation, hand hygiene, chlorhexidine oral care, and subglottic drainage. Spontaneous breathing and awakening trials have also consistently been shown to shorten the duration of mechanical ventilation and secondarily reduce the occurrence of VAP.
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Affiliation(s)
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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2
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Roshanzamiri S, Alemzadeh M, Ahmadizadeh SN, Behzad A, Hashemi SM, Salamzadeh J, Mirrahimi B. Probiotic prophylaxis to prevent ventilator-associated pneumonia in children on mechanical ventilation: A randomized double-blind clinical trial. Front Pediatr 2022; 10:1045941. [PMID: 36458140 PMCID: PMC9705346 DOI: 10.3389/fped.2022.1045941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Ventilator-Associated Pneumonia (VAP) is one of the most common nosocomial infections in the Pediatric Intensive Care Unit (PICU). Using new strategies to prevent nosocomial infections is crucial to avoid antibiotic resistance. One of these strategies is the utilization of probiotics. This study aims to investigate the efficacy of probiotic prophylaxis in preventing VAP in mechanically ventilated children. METHOD This study was a randomized, double-blind clinical trial. The study included 72 children under 12 years of age under mechanical ventilation for more than 48 h in the Mofid Children's Hospital. Patients were randomly divided into Limosilactobacillus reuteri DSM 17938 probiotic recipients (n = 38) and placebo groups (n = 34). In addition to the standard treatment, both groups received a sachet containing probiotics or a placebo twice a day. Children were screened for VAP based on clinical and laboratory evidence. RESULTS The mean age of children in the intervention and placebo groups was 4.60 ± 4.84 and 3.38 ± 3.49 years, respectively. After adjusting the other variables, it was observed that chance of VAP among probiotics compared to the placebo group was significantly decreased (OR adjusted = 0.29; 95% CI: 0.09-0.95). Also, probiotic was associated with a significantly lower chance of diarrhea than the placebo group (OR adjusted = 0.09; 95% CI: 0.01-0.96). CONCLUSION Probiotic utilization is effective in preventing the incidence of VAP and diarrhea in children under mechanical ventilation in the PICU.
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Affiliation(s)
- Soheil Roshanzamiri
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Alemzadeh
- Department of Pediatric Intensive Care, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyedeh Narjes Ahmadizadeh
- Department of Pediatric Intensive Care, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azita Behzad
- Department of Pediatric Intensive Care, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyedeh Masumeh Hashemi
- Department of Pediatric Intensive Care, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamshid Salamzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahador Mirrahimi
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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3
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Dhar S, Sandhu AL, Valyko A, Kaye KS, Washer L. Strategies for Effective Infection Prevention Programs: Structures, Processes, and Funding. Infect Dis Clin North Am 2021; 35:531-551. [PMID: 34362533 DOI: 10.1016/j.idc.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Successful Infection Prevention Programs (IPPs) consist of a multidisciplinary team led by a hospital epidemiologist and managed by infection preventionists. Knowledge of the economics of health care-associated infections (HAIs) and the ability to make a business plan is now essential to the success of programs. Prevention of HAIs is the core function of IPPs with impact on patient outcomes, quality of care, and cost savings for hospitals. This article discusses the structure and responsibilities of an IPP, the regulatory pressures and opportunities that these programs face, and how to build and manage a successful program.
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Affiliation(s)
- Sorabh Dhar
- Division of Infectious Diseases, Wayne State University, Harper University Hospital, 5 Hudson, 3990 John R, Detroit, MI 48201, USA; Department of Hospital Epidemiology and Infection Prevention, John D. Dingell VA Medical Center, Detroit, MI, USA.
| | - Avnish L Sandhu
- Division of Infectious Diseases, Wayne State University, Harper University Hospital, 5 Hudson, 3990 John R, Detroit, MI 48201, USA
| | - Amanda Valyko
- Department of Infection Prevention and Epidemiology, Michigan Medicine, 300 North Ingalls - NIB8B02, Ann Arbor, MI 48109-5479, USA
| | - Keith S Kaye
- Division of Infectious Diseases, University of Michigan, University of Michigan Medical School, 5510A MSRB 1, SPC 5680, 1150 West Medical Center Drive, Ann Arbor, MI 48109-5680, USA
| | - Laraine Washer
- Department of Infection Prevention and Epidemiology, Michigan Medicine, F4151 University Hospital South, 1500 East Medical Center Drive, SPC 5226, Ann Arbor, MI 48109-5226, USA; Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
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4
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Accurately Measuring Preventable Ventilator-associated Pneumonia Deaths Using Observational Data: It's about Time. Ann Am Thorac Soc 2021; 18:777-779. [PMID: 33929311 PMCID: PMC8086539 DOI: 10.1513/annalsats.202102-126ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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5
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Dantas EMGL, Lima SMF, Cantuária APC, Amorim IA, Almeida JA, Cunha TF, Franco OL, Rezende TMB. Synergistic activity of chlorhexidine and synoeca-MP peptide against Pseudomonas aeruginosa. J Cell Physiol 2019; 234:16068-16079. [PMID: 30740688 DOI: 10.1002/jcp.28265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 01/24/2023]
Abstract
This study aims to evaluate the in vitro antimicrobial and immunomodulatory activities and cytotoxicity of chlorhexidine (CHX) and synoeca-MP peptide alone or in combination against Pseudomonas aeruginosa. The antimicrobial property was evaluated by the determination of minimal inhibitory concentration, minimum bactericidal concentration, and planktonic bacteria and biofilm inhibition. Immunomodulatory activity was determined by enzyme-linked immunosorbent assay and nitric oxide production by the Griess reaction method. According to the results, synoeca-MP combined with CHX demonstrated antimicrobial effectiveness compared with its isolated use, in addition to immunomodulatory activity (upregulating MPC-1 and tumor necrosis factor-α and downregulating nitric oxide and interleukin-10). In this context, it is expected that the substances, together, could be capable of controlling bacterial infection and dissemination, besides potentiating macrophages' immune response against the studied microorganism. Moreover, reducing the CHX concentration by the addition of synoeca-MP peptide may, in a beneficial way, minimize the undesirable effects of both, CHX and synoeca-MP in a clinical setting.
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Affiliation(s)
- Elaine M G L Dantas
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Federal District, Brazil.,Curso de Odontologia, Escola de Saúde, Universidade Católica de Brasília, Campus 1, Brasília, Federal District, Brazil.,Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Escola de Saúde, Universidade Católica de Brasília, Campus Avançado Asa Norte, Brasília, Federal District, Brazil
| | - Stella M F Lima
- Curso de Odontologia, Escola de Saúde, Universidade Católica de Brasília, Campus 1, Brasília, Federal District, Brazil.,Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Escola de Saúde, Universidade Católica de Brasília, Campus Avançado Asa Norte, Brasília, Federal District, Brazil
| | - Ana Paula C Cantuária
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Federal District, Brazil
| | - Ingrid A Amorim
- Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Escola de Saúde, Universidade Católica de Brasília, Campus Avançado Asa Norte, Brasília, Federal District, Brazil
| | - Jeeser A Almeida
- Programa de Pós-Graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Tássio F Cunha
- Curso de Odontologia, Escola de Saúde, Universidade Católica de Brasília, Campus 1, Brasília, Federal District, Brazil
| | - Octávio L Franco
- Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Escola de Saúde, Universidade Católica de Brasília, Campus Avançado Asa Norte, Brasília, Federal District, Brazil.,Programa de Doutorado da Rede Centro-Oeste, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, Federal District, Brazil.,S-Inova Biotech, Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Mato Grosso do Sul, Brazil
| | - Taia M B Rezende
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Federal District, Brazil.,Curso de Odontologia, Escola de Saúde, Universidade Católica de Brasília, Campus 1, Brasília, Federal District, Brazil.,Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Escola de Saúde, Universidade Católica de Brasília, Campus Avançado Asa Norte, Brasília, Federal District, Brazil
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Vazquez Guillamet C, Kollef MH. Is Zero Ventilator-Associated Pneumonia Achievable?: Practical Approaches to Ventilator-Associated Pneumonia Prevention. Clin Chest Med 2019; 39:809-822. [PMID: 30390751 DOI: 10.1016/j.ccm.2018.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Ventilator-associated pneumonia (VAP) remains a significant clinical entity with reported incidence rates of 7% to 15%. Given the considerable adverse consequences associated with this infection, VAP prevention became a core measure required in most US hospitals. Many institutions implemented effective VAP prevention bundles that combined head of bed elevation, hand hygiene, chlorhexidine oral care, and subglottic drainage. More recently, spontaneous breathing and awakening trials have consistently been shown to shorten the duration of mechanical ventilation and secondarily reduce the occurrence of VAP. More recent data question the overall positive impact of prevention bundles, including some of their core component interventions.
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Affiliation(s)
- Cristina Vazquez Guillamet
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of New Mexico School of Medicine, 2425 Camino de Salud, Albuquerque, NM 87106, USA; Division of Infectious Diseases, University of New Mexico School of Medicine, 2425 Camino de Salud, Albuquerque, NM 87106, USA
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8052, St Louis, MO 63110, USA.
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Li L, Wang Q, Wang J, Liu K, Wang P, Li X, Yang J, Lu J, Li D, Wang L, Wang Z, Peng F. Development, validation and application of a ventilator-associated pneumonia prevention checklist in a single cardiac surgery centre. Intensive Crit Care Nurs 2018; 49:58-64. [PMID: 29605237 DOI: 10.1016/j.iccn.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/29/2017] [Accepted: 10/19/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The purpose of this study was to develop, validate and apply a ventilator-associated pneumonia prevention checklist in a single cardiac surgery centre. METHODS An initial checklist was designed based on the published care bundles for prevention of ventilator-associated pneumonia; the Delphi method used for validation. A total of 20 experts were invited to score the items and give suggestions for the checklist. The final checklist was then applied to patients receiving cardiac surgery. Non-compliance with the protocol and outcome indicators were observed. RESULTS Two rounds of Delphi were conducted. The final one-page checklist consisted of three main parts: (1) demographic data of the patient receiving cardiac surgery; (2) general assessment of the patient (3) checklist of prevention measures. The average time to complete the checklist was between two and four minutes. After the application of the checklist, the incidence of ventilator-associated pneumonia decreased from 14.48 to 5.47 episodes per thousand ventilator hours. In patients requiring >48 hours mechanical ventilation, the ventilator-associated pneumonia rate and duration of ventilation was significantly decreased. CONCLUSION A checklist was developed for ventilator associated pneumonia based on care bundles and validated using the Delphi method. The checklist appeared to be a useful tool in preventing ventilator associated pneumonia and shortening the ventilation time.
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Affiliation(s)
- Luolan Li
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qing Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jingjing Wang
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Kai Liu
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Pei Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xian Li
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jing Yang
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jing Lu
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Dian Li
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Li Wang
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhinong Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Fei Peng
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China.
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Abstract
This review documents important progress made in 2015 in the field of critical care. Significant advances in 2015 included further evidence for early implementation of low tidal volume ventilation as well as new insights into the role of open lung biopsy, diaphragmatic dysfunction, and a potential mechanism for ventilator-induced fibroproliferation. New therapies, including a novel low-flow extracorporeal CO2 removal technique and mesenchymal stem cell-derived microparticles, have also been studied. Several studies examining the role of improved diagnosis and prevention of ventilator-associated pneumonia also showed relevant results. This review examines articles published in the American Journal of Respiratory and Critical Care Medicine and other major journals that have made significant advances in the field of critical care in 2015.
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Affiliation(s)
- Martin Dres
- 1 Department of Critical Care, St. Michael's Hospital and the Critical Illness and Injury Research Centre, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada.,2 Interdepartmental Division of Critical Care and
| | - Jordi Mancebo
- 3 Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain
| | - Gerard F Curley
- 1 Department of Critical Care, St. Michael's Hospital and the Critical Illness and Injury Research Centre, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada.,2 Interdepartmental Division of Critical Care and.,4 Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada; and
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9
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Dhar S, Cook E, Oden M, Kaye KS. Building a Successful Infection Prevention Program: Key Components, Processes, and Economics. Infect Dis Clin North Am 2017; 30:567-89. [PMID: 27515138 DOI: 10.1016/j.idc.2016.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Infection control is the discipline responsible for preventing health care-associated infections (HAIs) and has grown from an anonymous field, to a highly visible, multidisciplinary field of incredible importance. There has been increasing focus on prevention rather than control of HAIs. Infection prevention programs (IPPs) have enormous scope that spans multiple disciplines. Infection control and the prevention and elimination of HAIs can no longer be compartmentalized. This article discusses the structure and responsibilities of an IPP, the regulatory pressures and opportunities that these programs face, and how to build and manage a successful program.
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Affiliation(s)
- Sorabh Dhar
- Department of Hospital Epidemiology and Infection Prevention, Detroit Medical Center, Detroit, MI, USA; Department of Medicine, Wayne State University, Detroit, MI, USA; Department of Hospital Epidemiology and Infection Prevention, John D Dingell VA Medical Center, Detroit, MI, USA; Harper University Hospital, 5 Hudson, 3990 John R, Detroit, MI 48201, USA.
| | - Evelyn Cook
- Duke Infection Control Outreach Network, Duke University Medical Center, 1610 Sycamore Street, Durham, NC 27707, USA
| | - Mary Oden
- Infection Prevention, Clinical Operations, Tenet Health, 1443 Ross Avenue Suite 1400, Dallas, TX 75202, USA
| | - Keith S Kaye
- Department of Hospital Epidemiology and Infection Prevention, Detroit Medical Center, Detroit, MI, USA; Department of Medicine, Wayne State University, Detroit, MI, USA; University Health Center, 4201 Saint Antoine, Suite 2B, Box 331, Detroit, MI 48201, USA
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Sands KM, Wilson MJ, Lewis MAO, Wise MP, Palmer N, Hayes AJ, Barnes RA, Williams DW. Respiratory pathogen colonization of dental plaque, the lower airways, and endotracheal tube biofilms during mechanical ventilation. J Crit Care 2016; 37:30-37. [PMID: 27621110 DOI: 10.1016/j.jcrc.2016.07.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/10/2016] [Accepted: 07/24/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE In mechanically ventilated patients, the endotracheal tube is an essential interface between the patient and ventilator, but inadvertently, it also facilitates the development of ventilator-associated pneumonia (VAP) by subverting pulmonary host defenses. A number of investigations suggest that bacteria colonizing the oral cavity may be important in the etiology of VAP. The present study evaluated microbial changes that occurred in dental plaque and lower airways of 107 critically ill mechanically ventilated patients. MATERIALS AND METHODS Dental plaque and lower airways fluid was collected during the course of mechanical ventilation, with additional samples of dental plaque obtained during the entirety of patients' hospital stay. RESULTS A "microbial shift" occurred in dental plaque, with colonization by potential VAP pathogens, namely, Staphylococcus aureus and Pseudomonas aeruginosa in 35 patients. Post-extubation analyses revealed that 70% and 55% of patients whose dental plaque included S aureus and P aeruginosa, respectively, reverted back to having a predominantly normal oral microbiota. Respiratory pathogens were also isolated from the lower airways and within the endotracheal tube biofilms. CONCLUSIONS To the best of our knowledge, this is the largest study to date exploring oral microbial changes during both mechanical ventilation and after recovery from critical illness. Based on these findings, it was apparent that during mechanical ventilation, dental plaque represents a source of potential VAP pathogens.
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Affiliation(s)
- Kirsty M Sands
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, Cardiff, Wales, UK.
| | - Melanie J Wilson
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, Cardiff, Wales, UK
| | - Michael A O Lewis
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, Cardiff, Wales, UK
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Nicki Palmer
- Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Anthony J Hayes
- Bioimaging Hub, School of Biosciences, Cardiff University, Cardiff, Wales, UK
| | - Rosemary A Barnes
- Cardiff Institute of Infection & Immunity, School of Medicine, Heath Park, Cardiff, Wales, UK
| | - David W Williams
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, Cardiff, Wales, UK
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