The association between oral bacteria, the cough reflex and pneumonia in patients with acute stroke and suspected dysphagia.
- 作者列表："Perry SE","Huckabee ML","Tompkins G","Milne T
OBJECTIVE:To establish how oral bacteria are related to cough sensitivity and pneumonia in a clinical stroke population. BACKGROUND:Stroke patients are at risk of colonisation by respiratory pathogens due, in part, to sudden discontinuation of effective oral hygiene. When combined with reduced cough reflex sensitivity, aspiration of contaminated oropharyngeal contents and can lead to pneumonia. Relationships between oral bacteria, cough sensitivity and pneumonia have not been established. MATERIALS AND METHODS:A total of 102 patients with acute stroke underwent saliva sampling and cough reflex testing at admission to hospital, discharge and one month. A qPCR assay compared levels of bacteria in saliva. Pneumonia events were recorded. RESULTS:Relative levels of bacteria were lowest at admission to hospital (6.04 × 10-6 ). There was a slight (non-significant) increase in bacterial levels at discharge (1.69 × 10-2 , P = .73). By one month, bacterial levels had significantly increased (9.17 × 10-2 ) relative to admission [P < .001] and discharge [P < .001]. Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli are not typically found in healthy mouths, yet were detected in 22% of patients during hospitalisation. Combined bacterial levels measured at one month was associated with pneumonia (P = .004) but there was no relationship to cough sensitivity. CONCLUSION:Acute stroke patients were at increased risk of colonisation from respiratory pathogens throughout their recovery. The presence of these pathogens in saliva at one month was associated with adverse respiratory events. Data support the development of protocols to explore risk factors and sequelae of microbiological changes in stroke.
目的: 在临床卒中人群中确定口腔细菌与咳嗽敏感性和肺炎的关系。 背景: 中风患者有呼吸道病原体定植的风险，部分原因是突然停止有效的口腔卫生。当合并咳嗽反射敏感性降低时，误吸污染的口咽内容物并可导致肺炎。口腔细菌、咳嗽敏感性和肺炎之间的关系尚未确定。 材料和方法: 对 102 例急性脑卒中患者在入院、出院及 1 个月时进行唾液采样和咳嗽反射检测。QPCR测定比较唾液中细菌的水平。记录肺炎事件。 结果: 入院时细菌相对水平最低 (6.04 × 10-6)。出院时细菌水平有轻微 (非显著性) 增加 (1.69 × 10-2，P = .73)。到一个月时，细菌水平相对于入院 [P < .001] 和出院 [P < .001] 显著增加 (9.17 × 10-2)。铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌通常不在健康口腔中发现，但在住院期间在 22% 的患者中检测到。在一个月时测量的联合细菌水平与肺炎相关 (P = .004)，但与咳嗽敏感性无关。 结论: 急性脑卒中患者在整个康复过程中呼吸道病原体定植的风险增加。1 个月时唾液中这些病原体的存在与不良呼吸事件相关。数据支持开发协议，以探索中风的风险因素和微生物变化的后遗症。
METHODS::The antimicrobial functions of neutrophils are facilitated by a defensive armamentarium of proteins stored in granules, and by the formation of neutrophil extracellular traps (NETs). However, the toxic nature of these structures poses a threat to highly vascularized tissues, such as the lungs. Here, we identified a cell-intrinsic program that modified the neutrophil proteome in the circulation and caused the progressive loss of granule content and reduction of the NET-forming capacity. This program was driven by the receptor CXCR2 and by regulators of circadian cycles. As a consequence, lungs were protected from inflammatory injury at times of day or in mouse mutants in which granule content was low. Changes in the proteome, granule content and NET formation also occurred in human neutrophils, and correlated with the incidence and severity of respiratory distress in pneumonia patients. Our findings unveil a 'disarming' strategy of neutrophils that depletes protein stores to reduce the magnitude of inflammation.
METHODS::Pneumonia is a common respiratory infectious disease that involves the inflammation of the pulmonary parenchyma. Periodontal disease is widespread and correlated with pneumonia. However, the relationship between periodontal treatment and clinical infectious outcomes in patients with pneumonia has remained undetermined. The aim of this study was to investigate the association between periodontal treatment and the risk of pneumonia events in the Taiwanese population. A nationwide population-based cohort study was conducted using data from the Taiwanese National Health Insurance Research Database (NHIRD). A total of 49,400 chronic periodontitis patients who received periodontal treatment from 2001 to 2012 were selected. In addition, 49,400 healthy individuals without periodontal diseases were picked randomly from the general population after propensity score matching according to age, gender, monthly income, urbanization, and comorbidities. The Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between the periodontal treatment cohort and the comparison cohort. The average ages of the periodontal treatment and comparison groups were 44.25 ± 14.82 years and 44.15 ± 14.5 years, respectively. The follow up durations were 7.66 and 7.41 years for the periodontal treatment and comparison groups, respectively. We found 2504 and 1922 patients with newly diagnosed pneumonia in the comparison cohort and the periodontal treatment cohort, respectively. The Kaplan-Meier plot revealed that the cumulative incidence of pneumonia was significantly lower over the 12 year follow-up period in the periodontal treatment group (using the log-rank test, p < 0.001). In conclusion, this nationwide population-based study indicated that the patients with periodontal treatment exhibited a significantly lower risk of pneumonia than the general population.
METHODS:OBJECTIVE:To describe the treatment of community-acquired pneumonia (CAP) in children under five years in Tanzania. METHODS:Between January and December 2017, children aged 2-59 months with chest radiography-confirmed CAP were enrolled. The parents were interviewed to collect information on the patients and home-based medication. Clinical information was derived from the patient files. Nasopharyngeal swab and blood samples were collected for isolation of the causative pathogens. Swab samples were analysed by quantitative PCR whereas blood samples were tested using BacT/Alert 3D. RESULTS:Overall, 109 children with CAP were included in this analysis. Provision of care to most children was delayed (median = 4.6 days). A quarter (26.6%) were given unprescribed/leftover antibiotics at home. Only one child had positive bacterial culture. Referrals were associated with nasopharyngeal carriage of Streptococcus pneumoniae (p = 0.003) and Haemophilus influenzae (p = 0.004). Of all admitted children, more than a quarter (n = 29) did not need to be hospitalised and inappropriately received injectable instead of oral antibiotics. CONCLUSION:We found high rates of home treatment, particularly with antibiotics. Appropriate health care was delayed for most children because of home treatment. Efforts are needed at the community level to improve awareness of antimicrobial resistance.