Short-duration selective decontamination of the digestive tract infection control does not contribute to increased antimicrobial resistance burden in a pilot cluster randomised trial (the ARCTIC Study).

OBJECTIVE: Selective decontamination of the digestive tract (SDD) is a well-studied but hotly contested medical intervention of enhanced infection control. Here, we aim to characterise the changes to the microbiome and antimicrobial resistance (AMR) gene profiles in critically ill children treated with SDD-enhanced infection control compared with conventional infection control. DESIGN: We conducted shotgun metagenomic microbiome and resistome analysis on serial oropharyngeal and faecal samples collected from critically ill, mechanically ventilated patients in a pilot multicentre cluster randomised trial of SDD. The microbiome and AMR profiles were compared for longitudinal and intergroup changes. Of consented patients, faecal microbiome baseline samples were obtained in 89 critically ill children. Additionally, samples collected during and after critical illness were collected in 17 children treated with SDD-enhanced infection control and 19 children who received standard care. RESULTS: SDD affected the alpha and beta diversity of critically ill children to a greater degree than standard care. At cessation of treatment, the microbiome of SDD patients was dominated by Actinomycetota, specifically Bifidobacterium, at the end of mechanical ventilation. Altered gut microbiota was evident in a subset of SDD-treated children who returned late longitudinal samples compared with children receiving standard care. Clinically relevant AMR gene burden was unaffected by the administration of SDD-enhanced infection control compared with standard care. SDD did not affect the composition of the oral microbiome compared with standard treatment. CONCLUSION: Short interventions of SDD caused a shift in the microbiome but not of the AMR gene pool in critically ill children at the end mechanical ventilation, compared with standard antimicrobial therapy.

Detection of lumpy skin disease virus reads in the human upper respiratory tract microbiome requires further investigation.

Lumpy skin disease virus (LSDV), a double-stranded DNA virus from the Capripoxvirus genus, primarily affects Bos indicus, Bos taurus breeds, and water buffalo. Arthropod vectors, including mosquitoes and biting flies, are the main LSDV transmitters. Although LSDV is not zoonotic, this study unexpectedly detected LSDV reads in the upper respiratory tract microbiome of humans from rural and urban areas in Maharashtra, India. Nasopharyngeal and oropharyngeal swab samples collected for SARS-CoV-2 surveillance underwent whole-genome metagenomics sequencing, revealing LSDV reads in 25% of samples. Split kmer analysis provided insights into sample relatedness despite the low coverage of LSDV reads with the reference genome. Our findings, which include the detection of LSDV contigs aligning to specific locations on the reference genome, suggest a common source for LSDV reads, potentially shared water sources, or milk/milk products. Further investigation is needed to ascertain the mode of transmission and reason for the detection of LSDV reads in human upper respiratory tract.

Self-sampling with oral rinse to detect oropharyngeal Neisseria gonorrhoeae among men who have sex with men: results from an exploratory study in Belgium (the SSONG Study).

OBJECTIVES: We aimed to assess whether a self-collected oral rinse was non-inferior to clinician-collected oropharyngeal swabs to detect Neisseria gonorrhoeae (Ng) using culture and nucleic acid amplification tests (NAAT) among men who have sex with men (MSM), and whether Ng may still be detected in oral rinses for a minimum of 5 days after collection. METHODS: MSM with a positive Ng result in an oropharyngeal or pooled sample (oropharynx, urethra and anorectum) were approached. Clinician-collected oropharyngeal swabs and oral rinses (15 mL sterile water) were taken. Ng culture and NAAT (Abbott 2000m RealTime System CT/NG assay and in-house PCR) were performed. Diagnostic accuracy was assessed using sensitivity and specificity, and agreement between both techniques using Cohen's kappa statistic. Aliquots of positive oral rinses were left at room temperature for a minimum of 5 days and reanalysed using NAAT. Lastly, participants filled in a questionnaire to explore perceptions of both methods. RESULTS: We included 100 participants between June 2022 and October 2023. 45 individuals (45 of 100) had a positive Ng result in either the oral rinses (42 of 45, 93%) or the swabs (36 of 45, 80%). Sensitivity was higher for oral rinses than swabs (sensitivity=0.93/0.80, specificity=1.0/1.0, respectively) and agreement between both techniques was good (kappa=0.75, p<0.001). Of the 42 positive oral rinses, 37 remained positive after a minimum of 5 days (88.1%). Using culture, 18 individuals had a positive Ng result in either the oral rinses (8 of 18, 44%) or the swabs (16 of 18, 88%). Most participants found the oral rinse easy or very easy to use and would be willing to use the oral rinse for home-based sampling. CONCLUSION: We detected more oropharyngeal Ng infections via NAAT using oral rinses than swab samples. However, swabs were better than oral rinses for culturing Ng. Oral rinses might allow for home-based self-sampling to detect oropharyngeal Ng.

Effect of oropharyngeal colostrum therapy on neonatal sepsis in preterm neonates: A systematic review and meta-analysis.

Various studies have shown that oropharyngeal colostrum application (OPCA) is beneficial to preterm neonates. We performed a systematic review and meta-analysis to assess whether OPCA reduces the incidence of culture-proven neonatal sepsis in preterm neonates. Randomized controlled trials comparing OPCA with placebo or standard care in preterm neonates were included. Medline, Embase, Web of Science, Cumulated Index to Nursing and Allied Health Literature, Scopus, and CENTRAL were searched for studies published up to June 15, 2023. We used the Cochrane Risk of Bias tool, version 2, for risk of bias assessment, the random-effects model (RevMan 5.4) for meta-analysis, and Gradepro software for assessing the certainty of evidence. Twenty-one studies involving 2393 participants were included in this meta-analysis. Four studies had a low risk of bias, whereas seven had a high risk. Oropharyngeal colostrum significantly reduced the incidence of culture-proven sepsis (18 studies, 1990 neonates, risk ratio [RR]: 0.78, 95% confidence interval [95% CI]: 0.65, 0.94), mortality (18 studies, 2117 neonates, RR: 0.73, 95% CI: 0.59, 0.90), necrotizing enterocolitis (NEC) (17 studies, 1692 neonates, RR: 0.59, 95% CI: 0.43, 0.82), feeding intolerance episodes (four studies, 445 neonates, RR: 0.59, 95% CI: 0.38, 0.92), and the time to full enteral feeding (19 studies, 2142 neonates, mean difference: -2 to 21 days, 95% CI: -3.44, -0.99 days). There was no reduction in intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, ventilator-associated pneumonia, neurodevelopmental abnormalities, hospital stay duration, time to full oral feeding, weight at discharge, pneumonia, and duration of antibiotic therapy. The certainty of the evidence was high for the outcomes of culture-positive sepsis and mortality, moderate for NEC, low for time to full enteral feeding, and very low for feeding intolerance. OPCA reduces culture-positive sepsis and mortality (high certainty), NEC (moderate certainty), and time to full enteral feeding (low certainty) in preterm neonates. However, scarcity of data from extremely premature infants limits the generalizability of these results to this population.

Insights into the role of the respiratory tract microbiome in defense against bacterial pneumonia.

The respiratory tract microbiome (RTM) is a microbial ecosystem inhabiting different niches throughout the airway. A critical role for the RTM in dictating lung infection outcomes is underlined by recent efforts to identify community members benefiting respiratory tract health. Obligate anaerobes common in the oropharynx and lung such as Prevotella and Veillonella are associated with improved pneumonia outcomes and activate several immune defense pathways in the lower airway. Colonizers of the nasal cavity, including Corynebacterium and Dolosigranulum, directly impact the growth and virulence of lung pathogens, aligning with robust clinical correlations between their upper airway abundance and reduced respiratory tract infection risk. Here, we highlight recent work identifying respiratory tract bacteria that promote airway health and resilience against disease, with a focus on lung infections and the underlying mechanisms driving RTM-protective benefits.

[A comparative assessment of microbiocenosis of saliva and oropharynx in patients with migraine]. / Sravnitel'naya otsenka mikrobiotsenoza slyuny i rotoglotki u patsientov s migren'yu.

OBJECTIVE: To identify changes in the microbiome of saliva and to compare it with the microbiome of the oropharynx of patients with migraine. MATERIAL AND METHODS: Sixty patients with migraine (21-56 years old), were examined using a headache diary, MIDAS and VAS. A microbiological examination of saliva and smear from the mucosa of the posterior wall of the oropharynx with evaluation by the method of mass spectrometry of microbial markers (MSMM) with the determination of 57 microorganisms was performed. All patients had comorbid chronic diseases of the gastrointestinal tract and upper respiratory tract (URT), according to anamnestic data and examination by specialists. RESULTS: A significant increase in the content of markers of resident (conditionally pathogenic) microorganisms characteristic of chronic diseases of URT (strepto- and staphylococci); markers of transient microorganisms characteristic of intestinal microflora (clostridia, gram-negative rods, anaerobes) that are normally absent; viral markers of cytomegaloviruses and herpes groups; a decrease in the content of fungi were identified in saliva. A comparative analysis of the microbiome of saliva and oropharynx showed: 1) a significant decrease in the concentration of coccal flora Enterococcus spp., Streptococcus mutans, Staphylococcus aureus, anaerobic bacteria Clostridium difficile and Clostridium perfringens in saliva; enterobacteria Helicobacter pylori; gram-negative rods Kingella spp., fungi and Epstein-Barr virus; 2) an increase in salivary concentrations of Staphylococcus epidermidis, anaerobic Clostridium ramosum and Fusobacterium spp./Haemophilus spp. and gram-negative bacilli Porphyromonas spp. CONCLUSION: A comparative assessment of the microbiota of a smear from the posterior wall of the oropharynx and saliva using MMSM showed the presence of dysbiosis both in the oropharynx and in the saliva of patients with migraine. However, there were fewer deviations from the norm in saliva, therefore, for diagnostic purposes, a smear from the posterior wall of the oropharynx is more significant as a biomarker for patients with migraine.

Tonsillectomies are associated with an increased risk of meningococcal carriage.

BACKGROUND: Neisseria meningitidis is a commensal organism with the potential to cause life-threatening disease. Colonisation is most common in adolescence and young adulthood. Various social factors have been associated with an increased risk of meningococcal carriage, but less is known about host factors that may influence the carriage status. Tonsillectomies have been shown to alter the pharyngeal microflora. This study assessed whether a history of tonsillectomy affects the risk of meningococcal colonisation. METHODS: Oropharyngeal swabs were collected from 15- to 16-year-old adolescents and 18- to 20-year-old young adults. Conventional culture methods and qPCR were used to detect meningococci. 16S qPCR was done to assess bacterial abundance in the samples. Data on history of tonsillectomies were collected from a central national database and the national university hospital. RESULTS: A total of 722 samples were collected; 197 from adolescents and 525 from young adults. Thirty-five participants were colonised with meningococci (4.8%). Eighty-eight participants had undergone a tonsillectomy, of which 10 (11.4%) carried meningococci, compared to 4% of those that had not. Prior tonsillectomy was associated with a threefold increased risk of meningococcal colonisation (OR 3.10, 95% CI 1.44-6.70, p = 0.004). Tonsillectomies remained a risk factor after adjusting for age, sex, recent antibiotic use and meningococcal vaccinations (aOR 2.49, 95% CI 1.13-5.48, p = 0.024). CONCLUSIONS: A history of tonsillectomy is associated with an increased risk of meningococcal colonisation. More studies are needed to shed light on the effects of tonsillectomies on the pharyngeal microbiome.

Oropharyngeal microbial ecosystem perturbations influence the risk for acute respiratory infections in common variable immunodeficiency.

Background: The respiratory tract microbiome is essential for human health and well-being and is determined by genetic, lifestyle, and environmental factors. Patients with Common Variable Immunodeficiency (CVID) suffer from respiratory and intestinal tract infections, leading to chronic diseases and increased mortality rates. While CVID patients' gut microbiota have been analyzed, data on the respiratory microbiome ecosystem are limited. Objective: This study aims to analyze the bacterial composition of the oropharynx of adults with CVID and its link with clinical and immunological features and risk for respiratory acute infections. Methods: Oropharyngeal samples from 72 CVID adults and 26 controls were collected in a 12-month prospective study. The samples were analyzed by metagenomic bacterial 16S ribosomal RNA sequencing and processed using the Quantitative Insights Into Microbial Ecology (QIME) pipeline. Differentially abundant species were identified and used to build a dysbiosis index. A machine learning model trained on microbial abundance data was used to test the power of microbiome alterations to distinguish between healthy individuals and CVID patients. Results: Compared to controls, the oropharyngeal microbiome of CVID patients showed lower alpha- and beta-diversity, with a relatively increased abundance of the order Lactobacillales, including the family Streptococcaceae. Intra-CVID analysis identified age >45 years, COPD, lack of IgA, and low residual IgM as associated with a reduced alpha diversity. Expansion of Haemophilus and Streptococcus genera was observed in patients with undetectable IgA and COPD, independent from recent antibiotic use. Patients receiving azithromycin as antibiotic prophylaxis had a higher dysbiosis score. Expansion of Haemophilus and Anoxybacillus was associated with acute respiratory infections within six months. Conclusions: CVID patients showed a perturbed oropharynx microbiota enriched with potentially pathogenic bacteria and decreased protective species. Low residual levels of IgA/IgM, chronic lung damage, anti antibiotic prophylaxis contributed to respiratory dysbiosis.

Streptococcus pneumoniae as a colonizing agent of the Nasopharynx - Oropharynx in adults: A systematic review and meta-analysis.

BACKGROUND: Streptococcus pneumoniae (Spn) is a commensal pathogen that usually colonizes the upper respiratory tract of children. Likewise, Spn colonization has been considered a critical factor in the development of pneumococcal invasive disease. However, Spn prevalence in adults remains unclear. This study performs a systematic review and meta-analysis to explore the prevalence of Spn Nasopharynx - Oropharynx Colonization (NOC) in adults. METHODS: A Systematic review of scientific databases was utilized to identify eligible studies that follow strict selection criteria. Subsequently, a meta-analysis was conducted to establish NOC prevalence in adults (≥18 years old). The heterogeneity and sensitivity analyses were assessed using the microorganism identification technique, sample type, and age subgroups. RESULTS: Initial selection includes 69 studies, with 37 selected for the meta-analysis, involving 23,724 individuals. The overall prevalence (95 % CI) of Spn NOC among adults was 6 % (5-9). The subgroup analysis revealed that young adults (YA), 18-64 years old, had a prevalence of 10 %, whereas older adults (OA), ≥65 years old, had a prevalence of 2 %. The identification of Spn NOC may vary depending on the method of diagnosis used. High heterogeneity (I2 > 90 %) was observed but diminished to 70 % when the analysis was restricted to oropharyngeal swabs as an identification method. Furthermore, heterogeneity decreased to 58 % when exclusively employing traditional culture as the identification method. CONCLUSIONS: This study found a low prevalence of Spn NOC in adults. Notably, the prevalence of Spn NOC was higher in younger adults than in older adults. It is essential to highlight a significant heterogeneity among studies, which indicates there is no standardized method of Spn NOC identification.

Comparative analysis of oropharyngeal microbiota in healthcare workers post-COVID-19.

Background: To date, more than 770 million individuals have become coronavirus disease 2019 (COVID-19) convalescents worldwide. Emerging evidence highlights the influence of COVID-19 on the oral microbiome during both acute and convalescent disease phases. Front-line healthcare workers are at an elevated risk of exposure to viral infections, and the effects of COVID-19 on their oral microbiome remain relatively unexplored. Methods: Oropharyngeal swab specimens, collected one month after a negative COVID-19 test from a cohort comprising 55 healthcare workers, underwent 16S rRNA sequencing. We conducted a comparative analysis between this post-COVID-19 cohort and the pre-infection dataset from the same participants. Community composition analysis, indicator species analysis, alpha diversity assessment, beta diversity exploration, and functional prediction were evaluated. Results: The Shannon and Simpson indexes of the oral microbial community declined significantly in the post-COVID-19 group when compared with the pre-infection cohort. Moreover, there was clear intergroup clustering between the two groups. In the post-COVID-19 group, the phylum Firmicutes showed a significant increase. Further, there were clear differences in relative abundance of several bacterial genera in contrast with the pre-infection group, including Streptococcus, Gemella, Granulicatella, Capnocytophaga, Leptotrichia, Fusobacterium, and Prevotella. We identified Gemella enrichment in the post-COVID-19 group, potentially serving as a recovery period performance indicator. Functional prediction revealed lipopolysaccharide biosynthesis downregulation in the post-COVID-19 group, an outcome with host inflammatory response modulation and innate defence mechanism implications. Conclusion: During the recovery phase of COVID-19, the oral microbiome diversity of front-line healthcare workers failed to fully return to its pre-infection state. Despite the negative COVID-19 test result one month later, notable disparities persisted in the composition and functional attributes of the oral microbiota.

Understanding Risk Factors for Oropharyngeal Gonorrhea Among Sex Workers Attending Sexual Health Clinics in 2 Australian Cities: Mixed Methods Study.

BACKGROUND: The risk factors for oropharyngeal gonorrhea have not been examined in sex workers despite the increasing prevalence of gonorrhea infection. OBJECTIVE: This study aims to determine the risk factors for oropharyngeal gonorrhea in female and gender-diverse sex workers (including cisgender and transgender women, nonbinary and gender fluid sex workers, and those with a different identity) and examine kissing, oral sex, and mouthwash practices with clients. METHODS: This mixed methods case-control study was conducted from 2018 to 2020 at 2 sexual health clinics in Melbourne, Victoria, and Sydney, New South Wales, Australia. We recruited 83 sex workers diagnosed with oropharyngeal gonorrhea (cases) and 581 sex workers without (controls). Semistructured interviews with 19 sex workers from Melbourne were conducted. RESULTS: In the case-control study, the median age of 664 sex workers was 30 (IQR 25-36) years. Almost 30% of sex workers (192/664, 28.9%) reported performing condomless fellatio on clients. Performing condomless fellatio with clients was the only behavior associated with oropharyngeal gonorrhea (adjusted odds ratio 3.6, 95% CI 1.7-7.6; P=.001). Most participants (521/664, 78.5%) used mouthwash frequently. In the qualitative study, almost all sex workers reported kissing clients due to demand and generally reported following clients' lead with regard to kissing style and duration. However, they used condoms for fellatio because they considered it a risky practice for contracting sexually transmitted infections, unlike cunnilingus without a dental dam. CONCLUSIONS: Our study shows that condomless fellatio is a risk factor for oropharyngeal gonorrhea among sex workers despite most sex workers using condoms with their clients for fellatio. Novel interventions, particularly targeting the oropharynx, will be required for oropharyngeal gonorrhea prevention.

Synergistic effect of Salvadora persica and chitosan nanoparticles against oropharyngeal microorganisms.

Herbal medicine combined with nanoparticles has caught much interest in clinical dental practice, yet the incorporation of chitosan with Salvadora persica (S. persica) extract as an oral care product has not been explored. The aim of this study was to evaluate the combined effectiveness of Salvadora persica(S. persica) and Chitosan nanoparticles (ChNPs) against oropharyngeal microorganisms. Agar well diffusion, minimum inhibitory concentration, and minimal lethal concentration assays were used to assess the antimicrobial activity of different concentrations of ethanolic extracts of S. persica and ChNPs against selected fungal strains, Gram-positive, and Gram-negative bacteria. A mixture of 10% S. persica and 0.5% ChNPs was prepared (SChNPs) and its synergistic effect against the tested microbes was evaluated. Furthermore, the strain that was considered most sensitive was subjected to a 24-h treatment with SChNPs mixture; and examined using SEM, FT-IR and GC-MS analysis. S. persica extract and ChNPs exhibited concentration-dependent antimicrobial activities against all tested strains. S. persica extract and ChNPs at 10% were most effective against S. pneumoni, K. pneumoni, and C. albicans. SEM images confirmed the synergistic effect of the SChNPs mixture, revealing S. pneumonia cells with increased irregularity and higher cell lysis compared to the individual solutions. GC-MS and FT-IR analysis of SChNPs showed many active antimicrobial phytocompounds and some additional peaks, respectively. The synergy of the mixture of SChNPs in the form of mouth-rinsing solutions can be a promising approach for the control of oropharyngeal microbes that are implicated in viral secondary bacterial infections.

Next-Generation Sequencing for Characterizing Respiratory Tract Virome and Improving Detection of Viral Pathogens in Children With Pneumonia.

BACKGROUND: Pneumonia is typically caused by a variety of pathogenic microorganisms. Traditional research often focuses on the infection of a few microorganisms, whereas metagenomic studies focus on the impact of the bacteriome and mycobiome on respiratory diseases. Reports on the virome characteristics of pediatric pneumonia remain relatively scarce. METHODS: We employed de novo assembly and combined homology- and feature-based methods to characterize the respiratory virome in whole-genome DNA sequencing samples from oropharynx (OP) swabs, nasopharynx (NP) swabs, and bronchoalveolar lavage fluids (BALF) of children with pneumonia. RESULTS: Significant differences were observed in the alpha and beta diversity indexes, as well as in the composition of the oropharyngeal virome, between pneumonia cases and controls. We identified 1137 viral operational taxonomic units (vOTUs) with significant differences, indicating a preference of pneumonia-reduced vOTUs for infecting Prevotella, Neisseria, and Veillonella, whereas pneumonia-enriched vOTUs included polyomavirus, human adenovirus, and phages targeting Staphylococcus, Streptococcus, Granulicatella, and Actinomyces. Comparative analysis revealed higher relative abundances and prevalence rates of pneumonia-enriched OP vOTUs in NP and BALF samples compared to pneumonia-reduced vOTUs. Additionally, virome analysis identified six pediatric patients with severe human adenovirus or polyomavirus infections, five of whom might have been undetected by targeted polymerase chain reaction (PCR)-based testing. CONCLUSIONS: This study offers insights into pediatric pneumonia respiratory viromes, highlighting frequent transmission of potentially pathogenic viruses and demonstrating virome analysis as a valuable adjunct for pathogen detection.

The effect of daily usage of Listerine Cool Mint mouthwash on the oropharyngeal microbiome: a substudy of the PReGo trial.

Introduction. ListerineÒ is a bactericidal mouthwash widely used to prevent oral health problems such as dental plaque and gingivitis. However, whether it promotes or undermines a healthy oral microbiome is unclear.Hypothesis/Gap Statement. We hypothesized that the daily use of Listerine Cool Mint would have a significant impact on the oropharyngeal microbiome.Aim. We aimed to assess if daily usage of Listerine Cool Mint influenced the composition of the pharyngeal microbiome.Methodology. The current microbiome substudy is part of the Preventing Resistance in Gonorrhoea trial. This was a double-blind single-centre, crossover, randomized controlled trial of antibacterial versus placebo mouthwash to reduce the incidence of gonorrhoea/chlamydia/syphilis in men who have sex with men (MSM) taking HIV pre-exposure prophylaxis (PrEP). Fifty-nine MSM taking HIV PrEP were enrolled. In this crossover trial, participants received 3 months of daily Listerine followed by 3 months of placebo mouthwash or vice versa. Oropharyngeal swabs were taken at baseline and after 3 months use of each mouthwash. DNA was extracted for shotgun metagenomic sequencing (Illumina Inc.). Non-host reads were taxonomically classified with MiniKraken and Bracken. The alpha and beta diversity indices were compared between baseline and after each mouthwash use. Differentially abundant bacterial taxa were identified using ANOVA-like differential expression analysis.Results. Streptococcus was the most abundant genus in most samples (n = 103, 61.7 %) with a median relative abundance of 31.5% (IQR 20.6-44.8), followed by Prevotella [13.5% (IQR 4.8-22.6)] and Veillonella [10.0% (IQR 4.0-16.8)]. Compared to baseline, the composition of the oral microbiome at the genus level (beta diversity) was significantly different after 3 months of Listerine (P = 0.006, pseudo-F = 2.29) or placebo (P = 0.003, pseudo-F = 2.49, permutational multivariate analysis of variance) use. Fusobacterium nucleatum and Streptococcus anginosus were significantly more abundant after Listerine use compared to baseline.Conclusion. Listerine use was associated with an increased abundance of common oral opportunistic bacteria previously reported to be enriched in periodontal diseases, oesophageal and colorectal cancer, and systemic diseases. These findings suggest that the regular use of Listerine mouthwash should be carefully considered.

Análise bacteriológica de mãos, região orofaríngea e equipamentos de proteção individual dos manipuladores de alimentos de um Restaurante Universitário no Rio de Janeiro / Bacteriological analysis of hands, orofaringea region and individual protection equipment of food manipulators of a university restaurant in Rio de Janeiro

Objetivo do trabalho, realizar análise bacteriológica de mãos, região nasal e orofaríngea e dos Equipamentos de Proteção Individual dos manipuladores de alimentos e correlacionar com as ações analisadas ao longo da cadeia produtiva. Pesquisa bacteriológica e observacional realizada no ano de 2016, em Restaurante Universitário/RJ, com 17 manipuladores, para contagem de Staphylococcus coagulase positiva, pesquisa de Salmonella spp. e Número Mais Provável de Escherichia coli totais e análise das ações dos manipuladores durante as atividades laborais. Na pesquisa bacteriológica para mãos e Equipamentos de Proteção Individual, obteve-se 22,4% de resultados positivos para as bactérias pesquisadas, com exceção da pesquisa para Salmonella com ausência em todas as análises; quanto a região nasal e orofaríngea, 35,3% foram positivas para Staphyloccocus spp. Conclui-se que o serviço possui falhas nos controles higiênico sanitários dos manipuladores, com riscos à saúde do consumidor.

BAHNG score: predictive model for detection of subjects with the oropharynx colonized by uncommon microorganisms / Escala BAHNG: modelo predictivo para la detección de sujetos colonizados en la orofaringe por microorganismos menos habituales

Objective. Pneumonia is most frequently produced by the microaspiration of flora that colonizes the oropharynx. Etiological diagnosis of pneumonia is infrequent in clinical practise and empirical treatment should be prescribed. The aims of the present study were to determine the factors associated with oropharynx colonization by uncommon microorganisms (UM) and to develop a predictive model. Methods. A cross-sectional study that included all patients living in one long-term care facilities was developed. Demographic, comorbidities, basal functional status and clinical data were collected. To determinate the oropharyngeal colonization, a single sample of pharynx was obtained for each subject using a cotton swab. Results. A total of 221 subjects were included, mean age 86.27 (SD 8.05) years and 157 (71%) were female. In 32 (14.5%) subjects UM flora was isolated, Gram-negative bacilli in 16 (7.2%) residents, and Staphylococcus aureus in 16 (7.2%). The predictive model included the presence of hypertension, neuromuscular disease, Barthel < 90 and use of PEG. The BAHNG score (BArthel, Hypertension, Neuromuscular, Gastrostomy), showed an area under the curve of 0.731 (CI 95% 0.643-0.820; p<0.001). We have classified patients according to this score in low (0-2 points), intermediate (3-5 points) and high risk (≥ 6). The probability of UM colonization in the oropharyngeal based on this classification is 4.1%, 15.8% and 57.1% for low, intermediate and high risk, respectively. Conclusion. The BAHNG score could help in the identifications of elderly patients with high risk of colonization by UM. In case of pneumonia the evaluation of the subject through this score could help in the initial decisions concerning antibiotic treatment (AU)

Objetivo. La neumonía se produce, con mayor frecuencia, por la microaspiración de la flora que coloniza la orofaringe. Su diagnóstico etiológico es infrecuente en la práctica clínica, prescribiéndose el tratamiento empíricamente. El objetivo del presente estudio fue determinar los factores asociados con la colonización de la orofaringe por microorganismos menos habituales y desarrollar un modelo predictivo. Métodos. Se realizó un estudio transversal que incluyó a todos los pacientes ingresados en una residencia de larga estancia. Se recogieron datos demográficos, comorbilidades, estado funcional basal y datos clínicos. Para determinar la colonización orofaríngea, se obtuvo una muestra única de la faringe para cada sujeto con un hisopo de algodón. Resultados. Se incluyeron un total de 221 sujetos, con una edad media de 86,27 (DE 8,05) años y 157 (71%) fueron mujeres. En 32 (14,5%) sujetos se aisló flora menos habitual: bacilos gramnegativos en 16 (7,2%) residentes y Staphylococcus aureus en 16 (7,2%). El modelo predictivo incluyó la presencia de hipertensión, enfermedad neuromuscular, Barthel <90 y tener gastrostomía endoscópica percutánea. La escala BAHNG (BArthel, Hipertensión, Neuromuscular, Gastrostomía) mostró un área bajo la curva de 0,731 (IC 95% 0,643-0,820; p <0,001). Se clasificó a los pacientes según la puntuación en bajo (0-2 puntos), intermedio (3-5 puntos) y alto riesgo (≥ 6). La probabilidad de colonización de la orofaringe por microorganismos menos habituales según esta clasificación fue del 4,1%, 15,8% y 57,1% para el riesgo bajo, intermedio y alto, respectivamente. Conclusión. La escala BAHNG podría ayudar en la identificación de pacientes ancianos con alto riesgo de colonización de la orofaringe por microorganismos menos habituales. En caso de neumonía, la evaluación del sujeto a través de esta escala podría ayudar en las decisiones iniciales sobre el tratamiento antibiótico a instaurar (AU)

Importancia de la flora microbiana orofaríngea en infecciones invasoras / Importance of the oropharyngeal microbial flora in invasive infections

La artritis séptica presenta una incidencia anual de 4 casos/100 000 niños. Es más frecuente en los miembros inferiores y suele estar provocada por Staphylococcus aureus vía hemática, por lo que la cobertura antibiótica inicial está dirigida a cubrir al menos este patógeno. Sin embargo, en algunas situaciones, como tras la manipulación periodontal o enfermedad dentaria, debemos pensar en microorganimos procedentes de la flora microbiana orofaríngea, como es Fusobacterium nucleatum, ya que el 50% de las cepas es resistente a penicilina y a algunas cefalosporinas, fármacos que forman parte del tratamiento antibiótico empírico de las infecciones osteoarticulares en la población pediátrica

Infectious arthritis has an annual incidence of 4 cases/100 000 children. Its more frequent location is the lower member and the most frequent microorganism involved is Staphylococcus aureus via bloodstream, so the initial antibiotic coverage is usually directed against this pathogen. However, in some situations such as periodontal disease, we must think of pathogens from the oropharyngeal microbial flora, for example Fusobacterium nucleatum, because 50% of them are penicillin and some cephalosporins resistant, which are part of the empirical antibiotic treatment of osteoarticular infections in the pediatric population

Nutritional, microbiological, and therapeutic factors related to mucositis in head and neck cancer patients: a cohort study / Factores nutricionales, microbiológicos y terapéuticos relacionados con el desarrollo de mucositis en pacientes con cáncer de cabeza y cuello: un estudio de cohorte

Purpose: the objective was to demonstrate if treatment modality, nutritional status and oropharyngeal flora contribute to the development of mucositis in radiotherapy-treated head and neck cancer. Methods: single-cohort study of patients with head and neck cancer (H&N) in which radiotherapy was indicated. Nutritional status was evaluated using SGA, BMI, and FFMI. A buccal smear was performed before radiotherapy for cultivation of bacteria and yeasts. Mucositis was evaluated using the WHO grades. Relative risk (RR) and its 95% CI were calculated. Results: the study included 35 patients, 74.3% males, 63.8 (9.9) years of age, and 34.3% malnourished. The diagnoses included larynx (40.0%), oral (25.7%), and pharynx cancer (11.4%). Treatment comprised 66.0 Gy of radiation, chemotherapy (60.0%), and surgery (57.1%). Bacteria were found in 28.6%, including Staphylococcus aureus (8.6%) and Escherichia coli (8.6%). Yeasts (Candida spp.) were found in 35.3%. Mucositis was more frequent in patients with definitive radiotherapy [100% vs. 65%, p = 0.01; RR = 1.54 (CI95% 1.12 to 2.12)]. Neither SGA nor BMI or FFMI were related to the development or severity of mucositis. Positive cultures for bacteria before radiotherapy were related to severe mucositis [44.4% vs. 12%, p = 0.039; RR = 4.17 (CI95% 1.22 to 14.24)], but there was no relationship with the presence of yeasts. Previous surgery was not associated with the appearance of the studied strains of bacteria. Conclusion: bacterial colonization of the oropharynx prior to radiotherapy may be a factor for severe mucositis in H&N patients (AU)

Objetivo: el objetivo fue demostrar si la modalidad de tratamiento, el estado nutricional y la flora orofaríngea contribuyen al desarrollo de mucositis en pacientes con cáncer de cabeza y cuello tratados con radioterapia. Métodos: estudio de cohorte de pacientes con cáncer de cabeza y cuello (CyC) tratados con radioterapia. El estado nutricional se evaluó utilizando VGS, IMC e IMM. Se realizó un frotis bucal antes de la radioterapia para el cultivo de bacterias y levaduras. Se evaluó la mucositis usando los criterios de la OMS. Se calcularon el riesgo relativo (RR) y su IC del 95%. Resultados: el estudio incluyó a 35 pacientes, 74,3% hombres, 63,8 (9,9) años de edad, y 34,3% desnutridos. Los tumores estaban localizados en laringe (40,0%), boca (25,7%) y faringe (11,4%). El tratamiento consistió en 66,0 Gy de radiación, quimioterapia (60,0%) y cirugía (57,1%). Se encontraron bacterias en 28,6%, incluyendo Staphylococcus aureus (8,6%) y Escherichia coli (8,6%). Se encontró Candida spp. en el 35,3%. La mucositis fue más frecuente en los pacientes con radioterapia radical [100% vs. 65%, p = 0,01; RR = 1,54 (IC95% 1,12 a 2,12)]. Ni VGS, IMC ni IMM se relacionaron con el desarrollo o la gravedad de la mucositis. Los cultivos positivos para bacterias antes de la radioterapia se relacionaron con mucositis severa [44,4% vs. 12%, p = 0,039; RR = 4,17 (IC95% 1,22 a 14,24)], pero no hubo ninguna relación con la presencia de levaduras. La cirugía no se asoció con la aparición de las cepas estudiadas de bacterias. Conclusión: la colonización bacteriana de la orofaringe antes de la radioterapia puede ser un factor para la mucositis graves en pacientes con cáncer CyC (AU)

Prior oropharyngeal colonization and ventilator-associated pneumonia

This study evaluated the relationship between previous colonization of the oropharynx and development of ventilator-associated pneumonia through the classification of genomic fingerprint pattern by pulsed-field gel electrophoresis of both oxacillin-resistant and oxacillin-susceptible Staphylococcus aureus isolates obtained from hospitalized patients in an intensive care unit.

Relationship between antibiotic consumption, oropharyngeal colonization, and ventilator-associated pneumonia by Staphylococcus aureus in an intensive care unit of a Brazilian teaching hospital / Relação entre consumo de antibióticos, colonização de orofaringe e pneumonia associada à ventilação por Staphylococcus aureus em um hospital de ensino brasileiro

INTRODUCTION: his study evaluated the consumption of major classes of antibiotics, the colonization of the oropharynx of patients on mechanical ventilation, and the risk of ventilator-associated pneumonia (VAP) caused by Staphylococcus aureus in an intensive care unit for adults. METHODS: A case-control study was carried out using colonized patients (cases) by oxacillin-resistant S. aureus (ORSA) and (controls) oxacillin-sensitive S. aureus (OSSA) from May 2009 to August 2010. The occurrence of VAP by S. aureus was also evaluated in the same period. Antibiotic consumption was expressed as the number of defined daily doses (DDD)/1,000 patient-days for glycopeptides, carbapenems, and extended-spectrum cephalosporins. RESULTS: Three hundred forty-six (56.1 percent) patients underwent mechanical ventilation with a frequency of oropharyngeal colonization of 36.4 percent, corresponding to 63.5 percent for ORSA and 36.5 percent for OSSA. The risk of illness for this organism was significant (p<0.05), regardless of whether colonization/infection was by ORSA or OSSA. The consumption of antibiotics was high, mainly for broad-spectrum cephalosporins (551.26 DDDs/1,000 patient-days). The high density of use of glycopeptides (269.56 DDDs/1,000 patient-days) was related to colonization by ORSA (Pearson r=0.57/p=0.02). Additionally, age >60 years, previous antibiotic therapy, and previous use of carbapenems were statistically significant by multivariate analysis. CONCLUSIONS: There was a significant relationship between the colonization of the oropharyngeal mucosa and the risk of VAP by both phenotypes. The use of glycopeptides was related to colonization by ORSA.

INTRODUÇÃO: Este estudo avaliou o consumo das principais classes de antibióticos, a colonização de orofaringe de pacientes sob ventilação mecânica e o risco de pneumonia associada à ventilação (PAV) causada por Staphylococcus aureus em uma unidade de terapia intensiva (UTI) de adultos. MÉTODOS: Foi realizado um estudo caso-controle, sendo caso os pacientes colonizados pelo oxacillin-resistant Staphylococcus aureus (ORSA), e controle aqueles pelo oxacillin-sensitive Staphylococcus aureus (OSSA), no período de maio de 2009 a agosto de 2010. A ocorrência de PAVs por S. aureus também foi avaliada no mesmo período. O consumo de antibióticos foi expresso pelo número de doses diárias definidas (DDDs)/1.000 pacientes-dia para glicopeptídeos, carbapenêmicos e cefalosporinas de amplo espectro. RESULTADOS: Trezentos e quarenta e seis (56,1 por cento) dos pacientes foram submetidos à ventilação mecânica com uma frequência de colonização de orofaringe de 36,4 por cento, correspondendo a 63,5 por cento e 36,5 por cento de ORSA e OSSA, respectivamente. O risco de adoecimento por este microrganismo foi significativo (p<0,05), considerando se a colonização/infecção foi por ORSA ou OSSA. O consumo de antibióticos foi alto, principalmente para cefalosporinas de amplo espectro (551,26 DDDs/1.000 pacientes-dia). A elevada densidade de uso de glicopetídeos (269,56 DDDs/1.000) foi relacionada com a colonização pelo ORSA (Pearson r=0.57/p=0.02). Adicionalmente, idade > 60 anos, terapia antibiótica prévia e uso prévio de carbapenêmicos foram estatisticamente significantes por análise multivariada. CONCLUSÕES: Foi observada uma relação significativa entre a colonização da mucosa de orofaringe e o risco de PAV por ambos fenótipos. O uso de glicopeptídos foi relacionado com a colonização pelo ORSA.