Oral colonization by hospital-associated bacterial pathogens among intensive care unit patients: Association with ventilatory support.

Abstract

Background: The oral cavity may serve as a reservoir of hospital-associated bacterial pathogens in critically ill patients. However, the prevalence of oral colonization and associated clinical factors remain incompletely characterized.

Methods: This multicenter cross-sectional study included 120 adult ICU patients from two Brazilian hospitals. Oral samples collected from the dorsal surface of the tongue were analyzed using conventional culture-based microbiological methods. Patients were classified according to ventilatory support (without invasive ventilation, endotracheal tube ventilation, or tracheostomy). Factors associated with oral colonization were evaluated using univariable and multivariable logistic regression analyses.

Results: Oral colonization by hospital-associated bacterial pathogens was identified in 77 patients (64.2%). Prevalence differed according to ventilatory support, affecting 42.5%, 60.0%, and 90.0% of patients without invasive ventilation, receiving endotracheal tube ventilation, and with tracheostomy, respectively (P < .001). Klebsiella pneumoniae (46.8%), Pseudomonas aeruginosa (28.6%), and Acinetobacter spp. (22.1%) were the predominant bacterial pathogens identified. Longer ICU stays were observed among colonized patients than non-colonized patients (17.7 ± 13.0 vs 9.4 ± 10.6 days, mean ± SD; P < .001). Tracheostomy remained independently associated with oral colonization (adjusted OR, 7.77; 95% CI, 2.18-27.75; P = .002).

Conclusions: Oral colonization by hospital-associated bacterial pathogens was highly prevalent and more frequent with increasing invasiveness of ventilatory support. Tracheostomy was independently associated with colonization, supporting systematic oral assessment and evidence-based oral healthcare within multidisciplinary ICU infection prevention strategies.