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Oropharyngeal flora as a source of bacteria colonizing the lower airways in patients on artificial ventilation

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Abstract

During 1 year 27 patients admitted to the respiratory intensive care unit were monitored bacteriologically for a minimum of 10 days (mean: 26.7 days). Oropharyngeal swabs and tracheal aspirates were qualitatively and semi-quantitatively cultured twice weekly. A correlation between oropharyngeal and tracheal flora was found: once a bacterial species colonized the oropharyngeal cavity in high numbers, the identical microorganism was frequently isolated (>50%) from the lower respiratory tract. Six of the 27 patients acquired an infection of the lower airways in the respiratory intensive care unit. The bacteria involved belonged to the patients oropharyngeal flora: S. aureus, Enterobacteriaceae and Pseudomonadaceae. As a result of this study showing the oropharynx to be the source of lower airway colonization/infection, a policy for infection prevention has been outlined. This policy is based on the concept of source elimination by means of oropharyngeal decontamination.

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References

  1. Atherton ST, White DJ (1978) Stomach as a source of bacteria colonizing respiratory tract during artificial ventilation. Lancet 1:968

    Google Scholar 

  2. Bartlett JG, Brewer NS, Ryan KJ (1978) Cumitech 7: Laboratory diagnosis of lower respiratory tract infections. Coordinating ed., JA Washington II. American Society for Microbiology, Washington, DC

    Google Scholar 

  3. Bryant LR, Trinkle JK, Mobin-Uddin K, Kaker J, Griffin WO (1972) Bacterial colonization profile with tracheal intubation and mechanical ventilation. Arch Surg 104:647

    Google Scholar 

  4. Casewell M, Phillips I (1977) Hands as route of transmission for Klebsiella species. Br Med J 2:1315

    Google Scholar 

  5. Crane LR, Lerner AM (1975) Gram-negative pneumonia in hospitalized patients. Postgrad Med 58:85

    Google Scholar 

  6. du Moulin GC, Paterson DG, Hedley-Whyte J, Lisbon A (1982) Aspiration of gastric bacteria in antacid treated patients: a frequent cause of post-operative colonization of the airway. Lancet 1:242

    Google Scholar 

  7. Greenfield S, Teres D, Bushnell LS, Hedley-Whyte J, Feingold DS (1973) Prevention of Gram-negative bacillary pneumonia using aerosol polymyxin as prophylaxis. I. Effect on the colonization pattern of the upper respiratory tract of seriously ill patients. J Clin Invest 52:2935

    Google Scholar 

  8. Klastersky J, Geuning C, Mouaward E, Daneau D (1972) Endotracheal gentamicin in bronchial infections in patients with tracheostomy. Chest 61:117

    Google Scholar 

  9. Kuipers JS (1970) Een bacteriologisch-epidemiologisch onderzoek van een beademingscentrum. Ph.D. thesis. Groningen

  10. Lowbury EJL, Thom BT, Lilly HA, Babb JR, Whittall K (1970) Sources of infection with Pseudomonus aeruginosa in patients with tracheostomy. J Med Microbiol 3:39

    Google Scholar 

  11. Orie NGM (1946) De aanwezigheid en de beteekenis, van gisten in de luchtwegen. Ph.D. thesis, Groningen

  12. Redman LR, Lockey E (1967) Colonization of the upper respiratory tract. Anaesthesia 22:220

    Google Scholar 

  13. Rogers LA, Osterhout S (1970) Pneumonia following tracheostomy. Am Surg 36:39

    Google Scholar 

  14. Schudel CFS, van Saene HKF (1979) Laryngectomy: oropharynx colonization and preventive treatment. In: van der Waaij D, Verhoef J (eds) New criteria for antimicrobial therapy: maintenance of digestive tract colonization resistance. Excerpta Medica, Amsterdam Oxford, p 189

    Google Scholar 

  15. Schwartz SN, Dowling JN, Benkovic C, DeQuittner-Buchanan M, Prostko T, Yee RB (1978) Sources of gram-negative bacilli colonizing the tracheae in intubated patients. J Inf Dis 138:227

    Google Scholar 

  16. Stevens RM, Teres D, Skillmann JJ, Feingold DS (1974) Pneumonia in an intensive care unit. Arch Int Med 134:106

    Google Scholar 

  17. Stoddart JC (1974) Gram-negative infections in the ICU. Critical Care Med 2:17

    Google Scholar 

  18. Stoutenbeek ChP, van Saene HKF, Miranda DR, Zandstra DF (1983) A new technique of infection prevention in the ICU by selective decontamination of the digestive tract. Proceedings Symposium. Acta Anaesth Belg 34:209

    Google Scholar 

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Authors and Affiliations

  1. Respiratory Intensive Care Unit, University Hospital Groningen, Groningen, The Netherlands

    R. van Uffelen & A. Löwenberg

  2. Department of Clinical Bacteriology, University Hospital Groningen, Groningen, The Netherlands

    H. K. F. van Saene

  3. Department of Statistics, University Hospital Groningen, Groningen, The Netherlands

    V. Fidler

Authors
  1. R. van Uffelen
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  2. H. K. F. van Saene
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  3. V. Fidler
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  4. A. Löwenberg
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van Uffelen, R., van Saene, H.K.F., Fidler, V. et al. Oropharyngeal flora as a source of bacteria colonizing the lower airways in patients on artificial ventilation. Intensive Care Med 10, 233–237 (1984). https://doi.org/10.1007/BF00256259

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  • DOI: https://doi.org/10.1007/BF00256259

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