Jones Deborah J, Munro Cindy L
University of Texas Health Science Center at Houston School of Nursing, 6901 Bertner Avenue, #660, Houston, TX 77030, USA.
Intensive Crit Care Nurs. 2008 Jun;24(3):152-61. doi: 10.1016/j.iccn.2008.01.004. Epub 2008 Apr 9.
Bacteraemia, defined as the presence of viable bacteria in the circulating blood can result in bloodstream infection, which is one of the most frequent and challenging hospital-acquired infections. Bacteraemia occurs in healthy populations with manipulation of the oral mucosa, including toothbrushing. Oral care is commonly administered to mechanically ventilated patients, it is important to determine whether this practice contributes to the incidence of bacteraemia. This paper reviews the literature on the link between the manipulation of the oral cavity and the development of bacteraemia in mechanically ventilated adults.
Searches were conducted using Medline, CINAHL, and the Cochrane Library databases. Article inclusion criteria were (1) a focus on mechanical ventilation and critical illness, (2) human subjects, (3) adult subjects, and (4) publication in English (or available English translation).
Nine articles met inclusion criteria and were critiqued. All relied upon clinical data as outcome measures; many were retrospective. The three organisms most often associated with nosocomial bloodstream infections were Staphylococcus aureus, coagulase negative staphylococci, and Enterococcus species. Establishing the origin of bacteraemia was problematic in most studies.
Additional research is needed to understand the relationship of oral care practices to bacteraemia in mechanically ventilated adults.
菌血症定义为循环血液中存在活细菌,可导致血流感染,这是最常见且具有挑战性的医院获得性感染之一。菌血症发生在包括刷牙在内的口腔黏膜受到操作的健康人群中。机械通气患者通常会接受口腔护理,确定这种做法是否会导致菌血症的发生很重要。本文综述了关于机械通气成人的口腔操作与菌血症发生之间联系的文献。
使用Medline、CINAHL和Cochrane图书馆数据库进行检索。文章纳入标准为:(1)关注机械通气和危重病,(2)人类受试者,(3)成年受试者,(4)以英文发表(或有可用的英文译文)。
9篇文章符合纳入标准并进行了分析。所有文章均依赖临床数据作为结局指标;许多是回顾性研究。与医院获得性血流感染最常相关的三种微生物是金黄色葡萄球菌、凝固酶阴性葡萄球菌和肠球菌属。在大多数研究中,确定菌血症的来源存在问题。
需要进一步研究以了解机械通气成人的口腔护理措施与菌血症之间的关系。