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Dental and microbiological risk factors for hospital-acquired pneumonia in non-ventilated older patients.

Ewan VC, Sails AD, Walls AW, Rushton S, Newton JL - PLoS ONE (2015)

Bottom Line: HAP was associated with increased length of stay (Fishers exact test, p=0.01), with mean 30 excess days (range -11.5-115).Target organisms were first detected within 72 hours of admission in 90% participants, but HAP was significantly associated with S. aureus/MRSA/P. aeruginosa/E. coli being detected at days 5 (OR 4.39, 95%CI1.73-11.16) or 14 (OR 6.69, 95%CI 2.40-18.60).Patients with lower limb fracture who were colonised orally with E. coli/ S. aureus/MRSA/P. aeruginosa after 5 days in hospital were at significantly greater risk of HAP (p = 0.002).

View Article: PubMed Central - PubMed

Affiliation: Newcastle University Institute for Ageing, Newcastle upon Tyne, United Kingdom.

ABSTRACT

Methods: We obtained a time series of tongue/throat swabs from 90 patients with lower limb fracture, aged 65-101 in a general hospital in the North East of England between April 2009-July 2010. We used novel real-time multiplex PCR assays to detect S. aureus, MRSA, E. coli, P. aeruginosa, S. pneumoniae, H. influenza and Acinetobacter spp. We collected data on dental/denture plaque (modified Quigley-Hein index) and outcomes of clinician-diagnosed HAP.

Results: The crude incidence of HAP was 10% (n = 90), with mortality of 80% at 90 days post discharge. 50% of cases occurred within the first 25 days. HAP was not associated with being dentate, tooth number, or heavy dental/denture plaque. HAP was associated with prior oral carriage with E. coli/S. aureus/P.aeruginosa/MRSA (p = 0.002, OR 9.48 95% CI 2.28-38.78). The incidence of HAP in those with carriage was 35% (4% without), with relative risk 6.44 (95% CI 2.04-20.34, p = 0.002). HAP was associated with increased length of stay (Fishers exact test, p=0.01), with mean 30 excess days (range -11.5-115). Target organisms were first detected within 72 hours of admission in 90% participants, but HAP was significantly associated with S. aureus/MRSA/P. aeruginosa/E. coli being detected at days 5 (OR 4.39, 95%CI1.73-11.16) or 14 (OR 6.69, 95%CI 2.40-18.60).

Conclusions: Patients with lower limb fracture who were colonised orally with E. coli/ S. aureus/MRSA/P. aeruginosa after 5 days in hospital were at significantly greater risk of HAP (p = 0.002).

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Related in: MedlinePlus

Consort diagram of screened study participants.
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pone.0123622.g001: Consort diagram of screened study participants.

Mentions: 341 patients were screened, with a final cohort of 90 patients who were followed up for HAP (Fig 1) and 93 patients from whom oral sampling data were available. Recruitment was difficult due to timing, and there were periods where there were few potential participants. This led to under-recruiting to the study, and the recruitment period could not be extended. Reasons for non-participation of eligible patients included logistic (n = 52 e.g. no personal consultee), moribund/aggressive (n = 35), in pain/too tired (n = 20), or no reason given (n = 83). Patients admitted on Friday/Saturday were frequently not recruited, which may have led to a more “well” cohort given the increased risks of weekend hospital admission [48]. 14/90 (16%) needed a personal or professional consultee. One patient was lost to follow-up, but his GP confirmed he had received no antibiotics post-discharge and he was therefore treated as not having developed HAP/LRTI. Three patients were found to be positive for MRSA and were treated with chlorhexidine mouth rinse and medicated toothpaste as part of the hospital’s decontamination protocol. None of these patients developed HAP.


Dental and microbiological risk factors for hospital-acquired pneumonia in non-ventilated older patients.

Ewan VC, Sails AD, Walls AW, Rushton S, Newton JL - PLoS ONE (2015)

Consort diagram of screened study participants.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4414413&req=5

pone.0123622.g001: Consort diagram of screened study participants.
Mentions: 341 patients were screened, with a final cohort of 90 patients who were followed up for HAP (Fig 1) and 93 patients from whom oral sampling data were available. Recruitment was difficult due to timing, and there were periods where there were few potential participants. This led to under-recruiting to the study, and the recruitment period could not be extended. Reasons for non-participation of eligible patients included logistic (n = 52 e.g. no personal consultee), moribund/aggressive (n = 35), in pain/too tired (n = 20), or no reason given (n = 83). Patients admitted on Friday/Saturday were frequently not recruited, which may have led to a more “well” cohort given the increased risks of weekend hospital admission [48]. 14/90 (16%) needed a personal or professional consultee. One patient was lost to follow-up, but his GP confirmed he had received no antibiotics post-discharge and he was therefore treated as not having developed HAP/LRTI. Three patients were found to be positive for MRSA and were treated with chlorhexidine mouth rinse and medicated toothpaste as part of the hospital’s decontamination protocol. None of these patients developed HAP.

Bottom Line: HAP was associated with increased length of stay (Fishers exact test, p=0.01), with mean 30 excess days (range -11.5-115).Target organisms were first detected within 72 hours of admission in 90% participants, but HAP was significantly associated with S. aureus/MRSA/P. aeruginosa/E. coli being detected at days 5 (OR 4.39, 95%CI1.73-11.16) or 14 (OR 6.69, 95%CI 2.40-18.60).Patients with lower limb fracture who were colonised orally with E. coli/ S. aureus/MRSA/P. aeruginosa after 5 days in hospital were at significantly greater risk of HAP (p = 0.002).

View Article: PubMed Central - PubMed

Affiliation: Newcastle University Institute for Ageing, Newcastle upon Tyne, United Kingdom.

ABSTRACT

Methods: We obtained a time series of tongue/throat swabs from 90 patients with lower limb fracture, aged 65-101 in a general hospital in the North East of England between April 2009-July 2010. We used novel real-time multiplex PCR assays to detect S. aureus, MRSA, E. coli, P. aeruginosa, S. pneumoniae, H. influenza and Acinetobacter spp. We collected data on dental/denture plaque (modified Quigley-Hein index) and outcomes of clinician-diagnosed HAP.

Results: The crude incidence of HAP was 10% (n = 90), with mortality of 80% at 90 days post discharge. 50% of cases occurred within the first 25 days. HAP was not associated with being dentate, tooth number, or heavy dental/denture plaque. HAP was associated with prior oral carriage with E. coli/S. aureus/P.aeruginosa/MRSA (p = 0.002, OR 9.48 95% CI 2.28-38.78). The incidence of HAP in those with carriage was 35% (4% without), with relative risk 6.44 (95% CI 2.04-20.34, p = 0.002). HAP was associated with increased length of stay (Fishers exact test, p=0.01), with mean 30 excess days (range -11.5-115). Target organisms were first detected within 72 hours of admission in 90% participants, but HAP was significantly associated with S. aureus/MRSA/P. aeruginosa/E. coli being detected at days 5 (OR 4.39, 95%CI1.73-11.16) or 14 (OR 6.69, 95%CI 2.40-18.60).

Conclusions: Patients with lower limb fracture who were colonised orally with E. coli/ S. aureus/MRSA/P. aeruginosa after 5 days in hospital were at significantly greater risk of HAP (p = 0.002).

Show MeSH
Related in: MedlinePlus