Scannapieco F A, Stewart E M, Mylotte J M
Department of Oral Biology, State University of New York, Buffalo.
Crit Care Med. 1992 Jun;20(6):740-5. doi: 10.1097/00003246-199206000-00007.
To assess the prevalence of oral colonization by respiratory pathogens in a group of ICU patients, with specific attention to dental plaque and the oral mucosa.
Prospective, nonrandomized study with age-matched controls.
Medical ICU in a tertiary-care Veterans Affairs Medical Center and a dental school outpatient preventive dentistry clinic.
Nonconsecutive, unselected patients admitted to the medical ICU during a 2-month period; controls were age-matched patients seen for the first time in the preventive dentistry clinic.
None.
Oral hygienic status was assessed in both groups using a semiquantitative system. Quantitative cultures of dental plaque and buccal mucosa were done within 12 hrs of medical ICU admission and every third day thereafter until discharge/death from the medical ICU. In controls, cultures of plaque and buccal mucosa were done on the initial visit only. Severity of illness of medical ICU patients was quantitated using the Acute Physiology and Chronic Health Evaluation (APACHE II) system and McCabe-Jackson criteria.
Oral hygiene of medical ICU patients was poor. These patients had a mean plaque score (1.9 +/- 0.2) that was significantly greater than that same score seen in outpatients of the preventive dentistry clinic (1.4 +/- 0.1; p less than .005). Plaque and/or oral mucosa of 22 (65%) of 34 medical ICU patients were colonized by respiratory pathogens, in contrast to only four (16%) of 25 preventive dentistry clinic patients (p less than .005). The potential respiratory pathogens cultured from medical ICU patients included methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and ten genera of Gram-negative bacilli. Colonization by respiratory pathogens was statistically associated with concomitant antibiotic therapy within the medical ICU group of patients, but not with severity of illness. Although medical ICU patients tended to have more dental plaque than preventive dentistry clinic patients, there was no statistically significant association noted between the presence of dental plaque and respiratory pathogen colonization.
These findings suggest that bacteria commonly causing nosocomial pneumonia colonize the dental plaque and oral mucosa of intensive care patients. In many cases, this colonization occurs by large numbers of bacteria. Dental plaque may be an important reservoir of these pathogens in medical ICU patients. Efforts to improve oral hygiene in medical ICU patients could reduce plaque load and possibly reduce oropharyngeal colonization.
评估一组重症监护病房（ICU）患者呼吸道病原体的口腔定植情况，尤其关注牙菌斑和口腔黏膜。
采用年龄匹配对照的前瞻性、非随机研究。
一家三级医疗退伍军人事务医疗中心的内科ICU和一所牙科学院的门诊预防牙科诊所。
在2个月期间入住内科ICU的非连续、未经过挑选的患者；对照组为首次到预防牙科诊所就诊的年龄匹配患者。
无。
两组均使用半定量系统评估口腔卫生状况。在入住内科ICU后12小时内以及此后每隔三天直至从内科ICU出院/死亡，对牙菌斑和颊黏膜进行定量培养。对照组仅在初次就诊时对牙菌斑和颊黏膜进行培养。使用急性生理学与慢性健康状况评分系统（APACHE II）和麦凯布 - 杰克逊标准对内科ICU患者的病情严重程度进行量化。
内科ICU患者的口腔卫生较差。这些患者的平均菌斑评分（1.9±0.2）显著高于预防牙科诊所门诊患者的相同评分（1.4±0.1；p<0.005）。34例内科ICU患者中有22例（65%）的牙菌斑和/或口腔黏膜被呼吸道病原体定植，相比之下，25例预防牙科诊所患者中只有4例（16%）（p<0.005）。从内科ICU患者中培养出的潜在呼吸道病原体包括耐甲氧西林金黄色葡萄球菌、铜绿假单胞菌和10属革兰氏阴性杆菌。在内科ICU患者组中，呼吸道病原体定植与同时使用抗生素治疗在统计学上相关，但与病情严重程度无关。尽管内科ICU患者的牙菌斑往往比预防牙科诊所患者更多，但牙菌斑的存在与呼吸道病原体定植之间未发现统计学上的显著关联。
这些发现表明，常见的引起医院获得性肺炎的细菌定植于重症监护患者的牙菌斑和口腔黏膜。在许多情况下，这种定植是由大量细菌引起的。牙菌斑可能是内科ICU患者这些病原体的重要储存库。改善内科ICU患者口腔卫生的努力可能会减少菌斑负荷，并可能减少口咽部定植。
