Scannapieco F A, Mylotte J M
Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, USA.
J Periodontol. 1996 Oct;67(10 Suppl):1114-22. doi: 10.1902/jop.1996.67.10s.1114.
Bacterial pneumonia is a prevalent and costly infection that is a significant cause of morbidity and mortality in patients of all ages. The continuing emergence of antibiotic-resistant bacteria (e.g., penicillin-resistant pneumococci) suggests that bacterial pneumonia will assume increasing importance in the coming years. Thus, knowledge of the pathogenesis of, and risk factors for, bacterial pneumonia is critical to the development of strategies for prevention and treatment of these infections. Bacterial pneumonia in adults is the result of aspiration of oropharyngeal flora into the lower respiratory tract and failure of host defense mechanisms to eliminate the contaminating bacteria, which multiply in the lung and cause infection. It is recognized that community-acquired pneumonia and lung abscesses can be the result of infection by anaerobic bacteria; dental plaque would seem to be a logical source of these bacteria, especially in patients with periodontal disease. It is also possible that patients with high risk for pneumonia, such as hospitalized patients and nursing home residents, are likely to pay less attention to personal hygiene than healthy patients. One important dimension of this personal neglect may be diminished attention to oral hygiene. Poor oral hygiene and periodontal disease may promote oropharyngeal colonization by potential respiratory pathogens (PRPs) including Enterobacteriaceae (Klebsiella pneumoniae, Escherichia coli, Enterobacter species, etc.), Pseudomonas aeruginosa, and Staphylococcus aureus. This paper provides the rationale for the development of this hypothesis especially as it pertains to mechanically ventilated intensive care unit patients and nursing home residents, two patient groups with a high risk for bacterial pneumonia.
细菌性肺炎是一种常见且代价高昂的感染性疾病，是各年龄段患者发病和死亡的重要原因。抗生素耐药菌（如耐青霉素肺炎球菌）的不断出现表明，细菌性肺炎在未来几年将变得越来越重要。因此，了解细菌性肺炎的发病机制和危险因素对于制定这些感染的预防和治疗策略至关重要。成人细菌性肺炎是口咽菌群吸入下呼吸道以及宿主防御机制未能清除污染细菌的结果，这些细菌在肺部繁殖并导致感染。人们认识到，社区获得性肺炎和肺脓肿可能是厌氧菌感染的结果；牙菌斑似乎是这些细菌的一个合理来源，尤其是在患有牙周病的患者中。肺炎高危患者，如住院患者和疗养院居民，也可能比健康患者更不注重个人卫生。这种个人忽视的一个重要方面可能是对口腔卫生的关注减少。口腔卫生差和牙周病可能会促进潜在呼吸道病原体（PRPs）在口咽部的定植，这些病原体包括肠杆菌科细菌（肺炎克雷伯菌、大肠杆菌、肠杆菌属等）、铜绿假单胞菌和金黄色葡萄球菌。本文阐述了这一假说形成的基本原理，特别是针对机械通气重症监护病房患者和疗养院居民这两类细菌性肺炎高危患者群体。
