2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Volume 27, Number 12, December 2015

Oral microbiota in older dysphagic patients

Figure 5 Pathogen load measured with the CPL in all groups and locations. OD-PNP, patients with oropharyngeal dysphagia and prior pneumonia; OD, patients with oropharyngeal dysphagia; OD-APN, patients with acute pneumonia and oropharyngeal dysphagia; H, healthy older persons. p -values are for comparison of a given group with healthy older persons. * p < 0.05; ** p < 0.01.

patients with OD. 15 In our study, we found that all older patients presented similar poor oral health and hygiene, slightly better in the control group. Patients with OD-APN, however, presented the highest rates of colonization and bacterial load by respiratory patho- gens, thus indicating that factors such as poor nutri- tional and health status also contribute to oral dysbiosis and colonization by respiratory pathogens. In consequence, oral health and hygiene assessment should be performed as a part of dysphagia assessment in older patients and oral hygiene recommendations should be provided to them and their caregivers. Appropriate mechanical toothbrushing and the use of antiseptic mouthwashes like chlorhexidine will reduce bacterial colonization and improve oral health and hygiene. Colonization by respiratory pathogens in all the groups reached 90% when any of the five pathogens and all anatomical locations were considered. Despite similarly poor oral health, control group were clearly

less colonized, both in terms of prevalence and pathogen load (CPL). A study with independently living older people (mean age 68.6 4.6 years) showed that prevalence of opportunistic respiratory pathogens in oral samples detected by culture techniques was 13.6% and that patients colonized were older than non- colonized patients. 50 The higher prevalence of colo- nization in our study is most likely due to the use of more sensitive and specific methodology and the inclusion of older frail patients with OD. Remarkably, oral colonization by respiratory patho- gens was more prevalent than nasal or nasopharyngeal colonization, normally considered the prime sites of colonization by respiratory pathogens. We hypothesize that high prevalence of oral colonization is related to poor oral hygiene, low clearance of pathogens through impaired salivary function and poor nutritional/ immunological status. Despite higher colonization by respiratory pathogens seen in dysphagic patients, TBL was similar among

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