Department of Medicine, Division of Infectious Diseases, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York.
J Am Geriatr Soc. 2018 Mar;66(3):590-594. doi: 10.1111/jgs.15190. Epub 2017 Dec 20.
This article is an evaluation of the literature on oral hygiene as a risk factor for nursing home-associated pneumonia (NHAP) and with interventions to improve oral hygiene and reduce the incidence of NHAP. The background for this article is that studies that have evaluated interventions to improve oral hygiene and prevent NHAP have conflicting results. To try to understand the reason for these results, the objective was to examine risk factor and intervention studies and determine their methodological validity. Review of studies evaluating oral hygiene status as a risk factor for NHAP found multiple methodological problems, resulting in limited evidence to support this association. Studies of intervention methods, whether finding benefit or not in preventing NHAP, all had methodological limitations. Therefore, it is unclear whether oral hygiene is a risk factor for NHAP and whether improving oral hygiene decreases the incidence of this infection. A recommendation is made that future studies should carefully define the etiology of suspected NHAP using molecular techniques when evaluating methods to prevent this infection because viral pneumonia and aspiration pneumonitis may mimic bacterial pneumonia even though, at times, there may be coinfection with bacteria. In this latter situation, improving oral hygiene may not prevent pneumonia. Therefore, viral infection and pneumonitis with or without bacterial coinfection need to be excluded so that the focus is on prevention of bacterial pneumonia.
这篇文章评估了口腔卫生作为养老院相关肺炎（NHAP）的危险因素的文献，并介绍了改善口腔卫生和降低 NHAP 发生率的干预措施。本文的背景是，评估改善口腔卫生和预防 NHAP 的干预措施的研究结果存在矛盾。为了尝试理解这些结果的原因，研究的目的是检查危险因素和干预研究，并确定其方法学的有效性。对评估口腔卫生状况作为 NHAP 危险因素的研究进行回顾发现，存在多种方法学问题，因此，仅有有限的证据支持口腔卫生与 NHAP 之间存在关联。无论是在预防 NHAP 方面是否发现获益，干预方法的研究都存在方法学上的局限性。因此，目前尚不清楚口腔卫生是否是 NHAP 的危险因素，以及改善口腔卫生是否能降低这种感染的发生率。建议未来的研究在评估预防这种感染的方法时，应使用分子技术仔细定义疑似 NHAP 的病因，因为病毒性肺炎和吸入性肺炎炎可能与细菌性肺炎相似，尽管有时可能存在细菌合并感染。在后一种情况下，改善口腔卫生可能并不能预防肺炎。因此，需要排除病毒性感染和肺炎，以及有无细菌合并感染，以便将重点放在预防细菌性肺炎上。
