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Correspondence |

High Prevalence of Pseudomonas aeruginosa From Oropharyngeal Biofilm in Patients With Cerebrovascular Infarction and Dysphagia FREE TO VIEW

Katsuhiko Hirota, DDS, PhD; Takeyoshi Yoneyama, DDS, PhD; Mayumi Sakamoto, RDH; Hiroshi Miyamoto, MD; Masanori Kurihara, MD, PhD; Shizuo Kayama, DDS, PhD; Keiji Murakami, DDS, PhD; Hiromichi Yumoto, DDS, PhD; Takashi Matsuo, DDS, PhD; Yoichiro Miyake, DDS, PhD
Author and Funding Information

From the Tokushima University Graduate School (Drs Hirota, Kayama, Murakami, Yumoto, Matsuo, and Miyake); the Yoneyama Dental Clinic (Dr Yoneyama); and the Chikamori Rehabilitation Hospital (Ms Sakamoto and Drs Miyamoto and Kurihara).

Correspondence to: Katsuhiko Hirota, DDS, PhD, Department of Oral Microbiology, Institute of Health Biosciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8504, Japan; e-mail: hirota@dent.tokushima-u.ac.jp


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(1):237-238. doi:10.1378/chest.10-0240
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Published online

To the Editor:

Aspiration pneumonia develops after the aspiration of colonized oropharyngeal contents.1 The elderly or patients with cerebrovascular disease (CVD) are often subjected to aspiration pneumonia because bacteria colonized in the oral cavity and oropharynx easily enter the lung during sleep and usually undergo repeated silent aspiration.2 Aspiration pneumonia is increasing in patients with dysphagia, and aspiration pneumonia-associated mortality is a most serious problem in elderly patients. Interestingly, it has been reported that oral health care for elderly patients in nursing homes reduces bacterial pneumonia.3,4 Therefore, it is very important to determine the characteristics of oropharyngeal microflora in patients with CVD to plan the optimum oral care to prevent aspiration pneumonia. From this standpoint, we investigated initial pharyngeal microflora in patients with CVD and dysphagia requiring daily nursing (Table 1). This study protocol was approved by the Ethics Committee of Chikamori Rehabilitation Hospital. We collected swab samples from the oropharynx of 55 patients with CVD (26 with dysphagia and 29 without dysphagia). To count the colony-forming units, the swabs, which were diffused into sterile medium, were inoculated onto agar plate using the spiral system as described previously.5 In addition to bacterial culture, polymerase chain reaction with bacterial-specific primers was used for bacterial identification. A higher prevalence (38.5%; 10/26) of Pseudomonas aeruginosa was observed in patients with CVD and dysphagia than in patients with CVD and without dysphagia (3.4%; 1/29; P < .01). The prevalence of Staphylococcus spp (30.7% and 24.1%, respectively) and Candida spp (46.2% and 31.0%, respectively) in both groups was similar. Moreover, the bacterial number of P aeruginosa in patients with CVD and dysphagia was significantly higher than in the group without dysphagia. Ten (47.6%) of 21 patients with CVD and dysphagia who needed complete or some assistance in daily living had P aeruginosa in their oropharyngeal microflora. Regarding the mode of nutritional intake, seven (63.6%) of 11 patients with CVD and dysphagia who were administered nutrition through a catheter had P aeruginosa in their oropharyngeal microflora. Interestingly, four (25%) of 16 patients with CVD and dysphagia whose test results were negative for P aeruginosa in oropharyngeal microflora were also administered nutrition through a catheter, and only one (3.4%) of 29 patients with CVD and without dysphagia had positive test results for P aeruginosa in oropharyngeal microflora. More importantly, these observations suggest that the high detection rate of P aeruginosa from oropharyngeal microflora in patients with CVD is increased by the status of dysphagia, not catheter use. Our data highlight that the care of oropharyngeal microflora, especially P aeruginosa, may be important to prevent aspiration pneumonia in patients with CVD and dysphagia.

Table Graphic Jump Location
Table 1 —Characteristics of Patients With CVD and With or Without Dysphagia and the Number of Patients Who Tested Positive for Pseudomonas aeruginosa in Oropharyngeal Microflora

+ = positive test results; − = negative test results; CFU = colony-forming units; CVD = cerebrovascular disease; ING = intermittent oronasal tube feeding; IOG = intermittent orogastric tube feeding.

a 

Percentage found in patients with CVD and with or without feeding disorders and dysphagia.

b 

Bacterial number of P aeruginosa in patients with CVD and dysphagia was significantly higher than in the group without dysphagia. Statistical analyses were performed using the Wilcoxon-Mann-Whitney signed rank test.

c 

Percentage of patients with positive test results for P aeruginosa found in the same degree group of functional independence for health care in daily living.

d 

Percentage of patients with positive test results for P aeruginosa found in the same mode group of nutritional intake.

Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;3449:665-671. [CrossRef] [PubMed]
 
Teramoto S, Yamamoto H, Yamaguchi Y, Ouchi Y, Matsuse T. A novel diagnostic test for the risk of aspiration pneumonia in the elderly. Chest. 2004;1252:801-802. [CrossRef] [PubMed]
 
Yoneyama T, Hashimoto K, Fukuda H, et al. Oral hygiene reduces respiratory infections in elderly bed-bound nursing home patients. Arch Gerontol Geriatr. 1996;221:11-19. [CrossRef] [PubMed]
 
Yoneyama T, Yoshida M, Matsui T, Sasaki H. Oral Care Working Group Oral Care Working Group Oral care and pneumonia. Lancet. 1999;3549177:515. [CrossRef] [PubMed]
 
Ishikawa A, Yoneyama T, Hirota K, Miyake Y, Miyatake K. Professional oral health care reduces the number of oropharyngeal bacteria. J Dent Res. 2008;876:594-598. [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 —Characteristics of Patients With CVD and With or Without Dysphagia and the Number of Patients Who Tested Positive for Pseudomonas aeruginosa in Oropharyngeal Microflora

+ = positive test results; − = negative test results; CFU = colony-forming units; CVD = cerebrovascular disease; ING = intermittent oronasal tube feeding; IOG = intermittent orogastric tube feeding.

a 

Percentage found in patients with CVD and with or without feeding disorders and dysphagia.

b 

Bacterial number of P aeruginosa in patients with CVD and dysphagia was significantly higher than in the group without dysphagia. Statistical analyses were performed using the Wilcoxon-Mann-Whitney signed rank test.

c 

Percentage of patients with positive test results for P aeruginosa found in the same degree group of functional independence for health care in daily living.

d 

Percentage of patients with positive test results for P aeruginosa found in the same mode group of nutritional intake.

References

Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;3449:665-671. [CrossRef] [PubMed]
 
Teramoto S, Yamamoto H, Yamaguchi Y, Ouchi Y, Matsuse T. A novel diagnostic test for the risk of aspiration pneumonia in the elderly. Chest. 2004;1252:801-802. [CrossRef] [PubMed]
 
Yoneyama T, Hashimoto K, Fukuda H, et al. Oral hygiene reduces respiratory infections in elderly bed-bound nursing home patients. Arch Gerontol Geriatr. 1996;221:11-19. [CrossRef] [PubMed]
 
Yoneyama T, Yoshida M, Matsui T, Sasaki H. Oral Care Working Group Oral Care Working Group Oral care and pneumonia. Lancet. 1999;3549177:515. [CrossRef] [PubMed]
 
Ishikawa A, Yoneyama T, Hirota K, Miyake Y, Miyatake K. Professional oral health care reduces the number of oropharyngeal bacteria. J Dent Res. 2008;876:594-598. [CrossRef] [PubMed]
 
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