Physiologic factors contributing to a transition in oral immunity among mechanically ventilated adults.
Ventilator-associated pneumonia (VAP), a specific type of nosocomial pneumonia, occurs in approximately 21% of patients in intensive care, and the mortality can be as high as 71%. VAP causes considerable mortality and morbidity, and it exponentially increases health care costs. The incidence of VAP is associated with oropharyngeal colonization of gram-negative bacteria. Within 48 h of hospital admission, the composition of the oropharyngeal flora of critically ill patients undergoes a change from the usual gram-positive streptococci and dental pathogens to a predominant gram-negative flora that includes more virulent organisms, which predispose patients to VAP. Identification and understanding of this oral transition from gram-positive to predominantly gram-negative flora may assist health care professionals in differentiating among oral immune markers that suggest compromised immunity. The purpose of this article is to provide a review of the literature that promotes an understanding of current knowledge about the transition of oral immunity in mechanically ventilated patients.
O'Neal
Pamela V
PV
Gordon College, University System of Georgia, Barnesville 30204, USA. poneal@falcon.gdn.peachnet.edu
Brown
Nicole
N
Munro
Cindy
C
D000328:Adult; D001422:Bacterial Adhesion; D003428:Cross Infection / Q000276:immunology*; D006801:Humans; D007109:Immunity; D009055:Mouth / Q000276:immunology / Q000382:microbiology; D011014:Pneumonia / Q000276:immunology* / Q000382:microbiology; D012121:Respiration, Artificial