title: High prevalence of colonization of oral cavity by respiratory pathogens in frail older patients with oropharyngeal dysphagia.
abstract: BACKGROUND
  Aspiration pneumonia (AP) is caused by dysfunctional swallowing resulting in aspiration of material colonized by respiratory pathogens. The aim of this study was to assess and compare the swallowing physiology, health status, oral health status, and oral/nasal microbiota in frail older patients (FOP) with oropharyngeal dysphagia (OD) and a control group.
  
  
  METHODS
  We studied 47 FOP (>70 year) with OD by videofluoroscopy (17 with acute pneumonia -APN-, 15 with prior pneumonia-PNP- and 15 without) and 14 older controls without OD (H). Oral/nasal colonization by five respiratory pathogens was evaluated by qPCR, whereas commensal microbiota composition was assessed by pyrosequencing.
  
  
  RESULTS
  (i) Frail older patients with OD presented similar comorbidities, poor functionality, polymedication, and prevalent videofluoroscopic signs of impaired safety of swallow (33.3-61.5%). However, patients with OD-APN also presented malnutrition, delayed laryngeal vestibule closure (409.23 ± 115.6 ms; p < 0.05), and silent aspirations (15.6%). (ii) Oral health was poor in all groups, 90% presented periodontitis and 72%, caries. (iii) Total bacterial load was similar in all groups, but higher in the oropharynx (>10(8) CFU/mL) than in the nose (<10(6) CFU/mL) (p < 0.0001). Colonization by respiratory pathogens was very high: 93% in OD patients (p < 0.05 vs H); 93% in OD-PNP (p < 0.05 vs H); 88% in OD-APN (p = 0.07 vs H), and lower in controls (67%).
  
  
  CONCLUSIONS
  Frail older patients with OD had impaired health status, poor oral health, high oral bacterial load, and prevalence of oral colonization by respiratory pathogens and VFS signs of impaired safety of swallow, and were therefore at risk for contracting AP.
authors.affiliation: Unitat d'Exploracions Funcionals Digestives, Departament de Cirurgia, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Ortega
authors.affiliation: Nestlé Research Center, Lausanne, Switzerland.
authors.forename: O
authors.initials: O
authors.lastname: Sakwinska
authors.affiliation: Nestlé Research Center, Lausanne, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Combremont
authors.affiliation: Nestlé Research Center, Lausanne, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Berger
authors.affiliation: Nestlé Research Center, Lausanne, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Sauser
authors.affiliation: Departament de Periodoncia, Universitat Internacional de Catalunya, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Parra
authors.affiliation: Departament de Periodoncia, Universitat Internacional de Catalunya, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Zarcero
authors.affiliation: Departament de Periodoncia, Universitat Internacional de Catalunya, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Nart
authors.affiliation: Unitat d'Exploracions Funcionals Digestives, Departament de Cirurgia, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Carrión
authors.affiliation: Unitat d'Exploracions Funcionals Digestives, Departament de Cirurgia, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.|Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Clavé
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000150:complications* / Q000382:microbiology*; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D009055:Mouth / Q000382:microbiology*; D009666:Nose / Q000382:microbiology; D011015:Pneumonia, Aspiration / Q000209:etiology* / Q000517:prevention & control*; D015995:Prevalence
keywords: aspiration pneumonia; geriatrics; oral microbiota; respiratory pathogens; swallowing disorders