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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

Risk of HAP by number of days in hospital.The risk of HAP declined with number of days in hospital, with the highest risk being in the first six weeks (green dashed lines). Around 50% of cases occurred within the first 25 days (red dashed lines).
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pone.0123622.g003: Risk of HAP by number of days in hospital.The risk of HAP declined with number of days in hospital, with the highest risk being in the first six weeks (green dashed lines). Around 50% of cases occurred within the first 25 days (red dashed lines).

Mentions: Two patients grew S. pneumoniae from sputum and a third grew H. influenzae (all three carried S. pneumoniae on oral study samples). Of the ten patients defined as having HAP, eight (80%) died, six in hospital and two after discharge. Total number of days in hospital for the 90 patients was 3454, and each patient was also followed up for 90 days post discharge (8100 days), giving a total of 11,554 days studied, and thus risk of first episode of HAP per day was 0.0009. Around 50% of cases arose within the first 25 days in hospital, and 75% occured within the first six weeks of admission (Fig 3). Having HAP was associated with a significantly increased length of stay (Fisher’s exact test, p = 0.01), with a mean excess number of days in hospital per person of 30 days (range -11.5–115).


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)

Risk of HAP by number of days in hospital.The risk of HAP declined with number of days in hospital, with the highest risk being in the first six weeks (green dashed lines). Around 50% of cases occurred within the first 25 days (red dashed lines).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0123622.g003: Risk of HAP by number of days in hospital.The risk of HAP declined with number of days in hospital, with the highest risk being in the first six weeks (green dashed lines). Around 50% of cases occurred within the first 25 days (red dashed lines).
Mentions: Two patients grew S. pneumoniae from sputum and a third grew H. influenzae (all three carried S. pneumoniae on oral study samples). Of the ten patients defined as having HAP, eight (80%) died, six in hospital and two after discharge. Total number of days in hospital for the 90 patients was 3454, and each patient was also followed up for 90 days post discharge (8100 days), giving a total of 11,554 days studied, and thus risk of first episode of HAP per day was 0.0009. Around 50% of cases arose within the first 25 days in hospital, and 75% occured within the first six weeks of admission (Fig 3). Having HAP was associated with a significantly increased length of stay (Fisher’s exact test, p = 0.01), with a mean excess number of days in hospital per person of 30 days (range -11.5–115).

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