2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Neurogastroenterology & Motility Reprinted by permission of Neurogastroenterol Motil. 2015; 27(12):1804-1816.

Neurogastroenterol Motil (2015) 27, 1804–1816

doi: 10.1111/nmo.12690

High prevalence of colonization of oral cavity by respiratory pathogens in frail older patients with oropharyngeal dysphagia

O. ORTEGA ,*, #

O. SAKWINSKA , † , #

S. COMBREMONT , † B. BERGER , † J. SAUSER , † C. PARRA , ‡ S. ZARCERO , ‡ J. NART , ‡

S. CARRION * & P. CLAVE *, §

*Unitat d’Exploracions Funcionals Digestives, Departament de Cirurgia, Hospital de Mataro, Universitat Autonoma de Barcelona, Mataro, Spain † Nestle Research Center, Lausanne, Switzerland ‡ Departament de Periodoncia, Universitat Internacional de Catalunya, Barcelona, Spain § Centro de Investigacion Biomedica en Red de enfermedades hepaticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain

Key Messages • Aspiration pneumonia (AP) has been defined as pneumonia contracted by a patient with oropharyngeal dysphagia (OD) following aspiration of colonized oropharyngeal material. • The aim of this study was to assess and compare the swallowing physiology, health status, oral health status, and oral/nasal microbiota in frail older patients with OD and a control group. • Swallowing function was assessed by videofluoroscopy and samples from eight anatomical locations in the oropharynx and nasopharynx were collected in order to analyze and compare oral and nasal microbiota and colonization by respiratory pathogens by qPCR and pyrosequencing. • Frail older patients with OD are at great risk of contracting aspiration pneumonia as they have: (i) Poor health status with multimorbidity, low functionality, polymedication, and poor nutritional status; (ii) OD and impaired safety of swallow with delayed swallow response; and (iii) poor oral hygiene with high colonization by respiratory pathogens. • We suggest a triple intervention in order to reduce the risk of AP among frail older patients: (i) early screening and identification of patients with OD and subsequent treatment using clinical tools available in all hospitals and nursing homes; (ii) nutritional assessment and treatment of malnutrition; and (iii) routine assessment of oral health and appropriate treatment of periodontal diseases.

Abstract Background Aspiration pneumonia (AP) is caused by dysfunctional swallowing resulting in aspiration of

material colonized by respiratory pathogens. The aim of this study was to assess and compare the swallow- ing physiology, health status, oral health status, and oral/nasal microbiota in frail older patients (FOP) with oropharyngeal dysphagia (OD) and a control group. Methods We studied 47 FOP ( > 70 year) with OD by videofluoroscopy (17 with acute pneumonia – APN-, 15 with prior pneumonia – PNP- and 15 without) and 14 older controls without OD (H). Oral/nasal colonization by five respiratory pathogens was evalu- ated by qPCR, whereas commensal microbiota com- position was assessed by pyrosequencing. Key Results (i) Frail older patients with OD presented similar

Address for Correspondence Pere Clave, MD, PhD, Associate Professor of Surgery, Department of Surgery, Hospital de Mataro, Universitat Autonoma de Barcelona, Carretera de Cirera s/n 08304, Mataro, Spain. Tel: +34 93 741 77 00; fax: +34 93 741 77 33; e-mail: pere.clave@ciberehd.org # Equal contributions. Received : 29 April 2015 Accepted for publication : 26 August 2015

© 2015 John Wiley & Sons Ltd

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