Rathbun Kimberly Paige, Sole Mary Lou, Yooseph Shibu, Xie Rui, Bourgault Annette M, Talbert Steven
Kimberly Paige Rathbun is a postdoctoral research fellow at Moffitt Cancer Center Department of Health Outcomes and Behavior, Tampa, Florida.
Mary Lou Sole is dean, professor, and Orlando Health Endowed Chair in Nursing at University of Central Florida College of Nursing, Orlando.
Am J Crit Care. 2025 May 1;34(3):208-217. doi: 10.4037/ajcc2025470.
Oral bacteria can be pathogenic and may change during hospitalization, potentially increasing risk for complications for older adults, including residents of skilled nursing facilities (SNFs).
To compare the oral microbiome at hospital admission by prehospital residence (SNF vs home) in older adults not receiving mechanical ventilation and to assess changes in their oral microbiome during hospitalization.
This prospective, observational study included 46 hospitalized adults (≥65 years old) not receiving mechanical ventilation, enrolled within 72 hours of hospitalization (15 admitted from SNF, 31 from home). Oral health was assessed with the Oral Health Assessment Tool at baseline and days 3, 5, and 7. Genomic DNA was extracted from unstimulated oral saliva specimens for microbiome profiling using 16S ribosomal RNA sequencing. Taxonomic composition, relative abundance, α-diversity (Shannon Index), and β-diversity (Bray-Curtis dissimilarity) of bacterial communities were determined.
Most patients were female (70%) and White (74%) or Hispanic (11%). Mean age was 78.7 years. More patients admitted from SNFs than from home had cognitive impairment (P < .001), delirium (P = .01), frailty (P < .001), and comorbidities (P = .04). Patients from SNFs had more oral bacteria associated with oral disease, lower α-diversity (P < .001), and higher β-diversity (P = .01). In the 28 study completers, α-diversity altered over time (P < .001). A significant interaction was found between groups after adjusting for covariates (P < .001).
Hospitalized older adults admitted from SNFs experience oral microbial and oral health disparities.
口腔细菌可能具有致病性，且在住院期间可能发生变化，这可能会增加老年人（包括专业护理机构[SNFs]的居民）出现并发症的风险。
比较未接受机械通气的老年人入院时根据院前居住情况（SNF与家中）的口腔微生物群，并评估其住院期间口腔微生物群的变化。
这项前瞻性观察性研究纳入了46名未接受机械通气的住院成年人（≥65岁），在住院72小时内入组（15名来自SNF，31名来自家中）。在基线以及第3、5和7天使用口腔健康评估工具评估口腔健康状况。从未受刺激的口腔唾液标本中提取基因组DNA，使用16S核糖体RNA测序进行微生物群分析。确定细菌群落的分类组成、相对丰度、α多样性（香农指数）和β多样性（布雷-柯蒂斯差异度）。
大多数患者为女性（70%），白人（74%）或西班牙裔（11%）。平均年龄为78.7岁。与来自家中的患者相比，来自SNF的患者有更多人存在认知障碍（P <.001）、谵妄（P =.01）、虚弱（P <.001）和合并症（P =.04）。来自SNF的患者有更多与口腔疾病相关的口腔细菌，α多样性较低（P <.001），β多样性较高（P =.01）。在28名研究完成者中，α多样性随时间发生变化（P <.001）。调整协变量后，两组之间存在显著交互作用（P <.001）。
从SNF入院的住院老年人存在口腔微生物和口腔健康差异。
