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2021 Vol.51, Issue 4 Preview Page

Original Article

Oral Microbiota Change in Intubated Patients under Mechanical Ventilation
Yoon Hee Choi1
,
Soo Hyun Kim2
,
Yeuni Yu3
,
Seo-Young Lee3
,
Yu Jung Jung4
,
Do Young Kim4
,
Myoung Soo Kim5
,
Hee Sam Na6*
1Department of Internal Medicine, Dongnam Institute of Radiological and Medical Sciences, Busan 46033, Republic of Korea
2Artificial Kidney Room, Busan Medical Center, Busan 47527, Republic of Korea
3Interdisplinary Program of Genomic Science, Pusan National University, Busan 46241, Republic of Korea
4School of Dentistry, Pusan National University, Yangsan 50612, Republic of Korea
5Department of Nursing, College of Natural Science, Pukyong National University, Busan 48513, Republic of Korea
6Department of Oral Microbiology, BK21 PLUS Project, School of Dentistry, Pusan National University, Yangsan 50612, Republic of Korea
*heesamy@pusan.ac.kr
31 December 2021. pp. 163-171
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Abstract

One of the complications that may develop in intubated patients under mechanical ventilator is ventilator‐associated pneumonia (VAP). In most cases, VAP appears to result from aspiration of the oropharyngeal microflora or colonizing pathogens. For efficient prevention and management, understanding oral microbiome dynamics during mechanical ventilator is required. In this study, we analyzed longitudinal oral microbiome in intubated patients under mechanical ventilation support. Intubated patients and healthy subjects were recruited for this study. Buccal samples were collected for microbiome study. For longitudinal comparison, intubated samples were grouped as initial 2 days, first week, second week, third week, and over 3 week group. 16S ribosomal RNA next generation sequencing was applied for microbiome analysis. Alpha diversity and beta diversity was applied to characterize the oral microbiome. Linear discriminant analysis effect size (LefSe) was applied to determine difference in the composition among tested group. In intubated patients, the richness and evenness of the microbiota was significantly reduced compared to the healthy control. The most abundant species in intubated patients were Corynebacterium, Acinetobacter, Streptococcus, Staphylococcus, and Enterococcus, which represented more than 70% of the total sequences at the genus level. The most abundant species were Acinetobacter baumannii, Proteus mirabilis, Enterococcus faecalis Pseudomonas aeruginosa, and Gardnerella vaginalis were among the significant taxa within intubated patients. Pathogenic bacteria including Acinetobacter, Enterococcus, Klebsiella, Pseudomonas, and Staphylococcus were also frequently observed during the observation period. In intubated patients, the composition of oral microbiome was heavily distorted compared to healthy subjects and high abundance of pathogenic bacteria was observed. A better understanding of the longitudinal microbiome change in oral cavity of intubated patients should provide better understanding for effective prophylactic and therapeutic interventions for VAP.

Keywords
Oral microbiota
Intubation
Mechanical ventilator
Ventilator associated pneumonia
References
1

Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia: a review. Eur J Intern Med 2010;21:360-8.

10.1016/j.ejim.2010.07.00620816584
2

Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, et al. Oral hygiene care for critically ill patients to prevent ventilator- associated pneumonia. Cochrane Database Syst Rev 2013:CD008367.

10.1002/14651858.CD008367.pub2
3

Labeau SO, Van de Vyver K, Brusselaers N, Vogelaers D, Blot SI. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet Infect Dis 2011;11:845-54.

10.1016/S1473-3099(11)70127-X
4

Alhazzani W, Smith O, Muscedere J, Medd J, Cook D. Toothbrushing for critically ill mechanically ventilated patients: a systematic review and meta-analysis of randomized trials evaluating ventilator-associated pneumonia. Crit Care Med 2013;41:646-55.

10.1097/CCM.0b013e3182742d4523263588
5

El-Solh AA, Pietrantoni C, Bhat A, Okada M, Zambon J, Aquilina A, et al. Colonization of dental plaques: a reservoir of respiratory pathogens for hospital-acquired pneumonia in institutionalized elders. Chest 2004;1261575-82.

10.1016/S0012-3692(15)31374-X
6

Shay K, Scannapieco FA, Terpenning MS, Smith BJ, Taylor GW. Nosocomial pneumonia and oral health. Spec Care Dentist 2005;25:179-87.

10.1111/j.1754-4505.2005.tb01647.x16295222
7

Rello J, Diaz E. Pneumonia in the intensive care unit. Crit Care Med 2003;31:2544-51.

10.1097/01.CCM.0000089928.84326.D214530765
8

Brennan MT, Bahrani-Mougeot F, Fox PC, Kennedy TP, Hopkins S, Boucher RC, et al. The role of oral microbial colonization in ventilator-associated pneumonia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:665-72.

10.1016/j.tripleo.2004.06.00515583538
9

Modi AR, Kovacs CS. Hospital-acquired and ventilator-associated pneumonia: Diagnosis, management, and prevention. Cleve Clin J Med 2020;87:633-9.

10.3949/ccjm.87a.1911733004324
10

Kitsios GD, Fitch A, Manatakis DV, Rapport SF, Li K, Qin S, et al. Respiratory Microbiome Profiling for Etiologic Diagnosis of Pneumonia in Mechanically Ventilated Patients. Front Microbiol 2018;9:1413.

10.3389/fmicb.2018.0141330042738PMC6048198
11

Özçaka Ö, Başoğlu OK, Buduneli N, Taşbaken MS, Bacakoğlu F, Kinane DF. Chlorhexidine decreases the risk of ventilator- associated pneumonia in intensive care unit patients: a randomized clinical trial. J Periodontal Res 2012;47:584-92.

10.1111/j.1600-0765.2012.01470.x22376026
12

Tuon FF, Gavrilko O, Almeida S, Sumi ER, Alberto T, Rocha JL, et al. Prospective, randomised, controlled study evaluating early modification of oral microbiota following admission to the intensive care unit and oral hygiene with chlorhexidine. J Glob Antimicrob Resist 2017;8:159-63.

10.1016/j.jgar.2016.12.00728216018
13

Benson AK, Kelly SA, Legge R, Ma F, Low SJ, Kim J, et al. Individuality in gut microbiota composition is a complex polygenic trait shaped by multiple environmental and host genetic factors. Proc Natl Acad Sci U S A 2010;107:18933-8.

10.1073/pnas.100702810720937875PMC2973891
14

Deo PN, Deshmukh R. Oral microbiome: Unveiling the fundamentals. J Oral Maxillofac Pathol 2019:23:122-8.

10.4103/jomfp.JOMFP_152_1931942127PMC6948042
15

Somineni HK, Kugathasan S. The Microbiome in Patients With Inflammatory Diseases. Clin Gastroenterol Hepatol 2019;17:243-55.

10.1016/j.cgh.2018.08.07830196163
16

Singh J. International conference on harmonization of technical requirements for registration of pharmaceuticals for human use. J Pharmacol Pharmacother 2015;6:185-7.

10.4103/0976-500X.16200426312010PMC4544148
17

Bonham PA. Swab cultures for diagnosing wound infections: a literature review and clinical guideline. J Wound Ostomy Continence Nurs 2009;36:389-95.

10.1097/WON.0b013e3181aaef7f19609159
18

Klindworth A, Pruesse E, Schweer T, Peplies J, Quast C, Horn M, et al. Evaluation of general 16S ribosomal RNA gene PCR primers for classical and next-generation sequencing-based diversity studies. Nucleic Acids Res 2013;41:e1.

10.1093/nar/gks80822933715PMC3592464
19

Hall M, Beiko RG. 16S rRNA Gene Analysis with QIIME2. Methods Mol Biol 2018;1849:113-29.

10.1007/978-1-4939-8728-3_830298251
20

Wade WG. The oral microbiome in health and disease. Pharmacol Res 2013;69:137-43.

10.1016/j.phrs.2012.11.00623201354
21

Segata N, Izard J, Waldron L, Gevers D, Miropolsky L, Garrett WS, et al. Metagenomic biomarker discovery and explanation. Genome Biol 2011;12:R60.

10.1186/gb-2011-12-6-r6021702898PMC3218848
22

Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867-903.

10.1164/ajrccm.165.7.210507811934711
23

Bahrani-Mougeot FK, Paster BJ, Coleman S, Barbuto S, Brennan MT, Noll J, et al. Molecular analysis of oral and respiratory bacterial species associated with ventilator-associated pneumonia. J Clin Microbiol 2007;45:1588-93.

10.1128/JCM.01963-0617301280PMC1865865
24

Jakobsson HE, Jemberg C, Andersson AF, Sjölund-Karisson M, Jansson JK, Engstrand L. Short-term antibiotic treatment has differing long-term impacts on the human throat and gut microbiome. PloS one 2010;5:e9836.

10.1371/journal.pone.000983620352091PMC2844414
25

Baek MG, Woo SJ, Kim NE, Baek C, Won S, Kim Y, et al. Respiratory microbiome profiles differ by recent hospitalization and nursing home residence in patients on mechanical ventilation. J Transl Med 2020;18:464.

10.1186/s12967-020-02642-z33287847PMC7720271
26

Harding CM, Hennon SW, Feldman MF. Uncovering the mechanisms of Acinetobacter baumannii virulence. Nat Rev Microbiol 2018;16:91-102.

10.1038/nrmicro.2017.14829249812PMC6571207
27

Song JH. Treatment recommendations of hospital-acquired pneumonia in Asian countries: first consensus report by the Asian HAP Working Group. Am J Infect Control 2008;36:S84-92.

10.1016/j.ajic.2007.01.01518468550
28

Kwak YG, Cho YK, Kim JR, Lee SO, Kim HY, Kim YK, et al. Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Data Summary from July 2008 through June 2009 and Analysis of 3-Year Results. Korean J Nosocomial Infect Control 2010;15:14-25.

Information
  • Publisher :The Korean Society for Microbiology and The Korean Society of Virology
  • Publisher(Ko) :대한미생물학회‧대한바이러스학회
  • Journal Title :JOURNAL OF BACTERIOLOGY AND VIROLOGY
  • Volume : 51
  • No :4
  • Pages :163-171
  • Received Date : 2021-09-03
  • Revised Date : 2021-09-27
  • Accepted Date : 2021-09-27
  • DOI :https://doi.org/10.4167/jbv.2021.51.4.163
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