JAMDA
Volume 11, Issue 1 , Pages 70-77 , January 2010

Preventing Aspiration in the Nursing Home: The Role of Biofilm and Data from the ICU

  • Paul Drinka, MD, CMD

      Affiliations

    • Corresponding Author InformationAddress correspondence to Paul Drinka, MD, CMD, University of Wisconsin, Madison, Medical College of Wisconsin, Milwaukee, N3379 Bailey Street, Waupaca, WI 54981.

References 

  1. Mylotte JM, Goodnough S, Gould M. Pneumonia versus aspiration pneumonitis in nursing home residents: Prospective application of a clinical algorithm. J Am Geriatr Soc. 2005;53:755–761
  2. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344:665–671
  3. Loeb M, Bentley DW, Bradley S, et al. Development of minimum criteria for the initiation of antibiotics in residents of long-term care facilities: Results of a consensus conference. Infect Control Hosp Epidemiol. 2001;22:120–124
  4. Matsue T, Oka T, Kida K, Fukuchi Y. Importance of diffuse aspiration bronchiolitis caused by chronic occult aspiration in the elderly. Chest. 1996;110:1289–1293
  5. Mukhopadhyay S, Katzenstein ALA. Pulmonary disease due to aspiration of food and other particulate matter: A clinicopathological study of 59 cases diagnosed on biopsy or resection specimens. Am J Surg Pathol. 2007;31:752–759
  6. Tobin RW, Pope CE, Pellegrini CA, et al. Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 1998;158:1804–1808
  7. Drinka PJ, Crnich CJ. Pneumonia in the nursing home. J Am Med Dir Assoc. 2005;6:342–350
  8. Potera C. Forging a link between biofilms and disease. Science. 1999;283:1837–1839
  9. Prince AA, Steiger JD, Khalid AN, et al. Prevalence of biofilms-forming bacteria in chronic rhinosinusitis. Am J Rhinol. 2008;22:239–245
  10. Gander S. Bacterial biofilms: Resistance to antimicrobial agents. J Antimicrob Chemother. 1996;37:1047–1050
  11. Kobayashi H. Airway biofilms: Implications for pathogenesis and therapy of respiratory tract infections. Treat Respir Med. 2005;4:241–253
  12. Psaltis AJ, Weitzel EK, Ha KR, Wormaid PJ. The effect of bacterial biofilms on post-sinus surgical outcomes. Am J Rhinol. 2008;22:1–6
  13. Sanclement JA, Webster P, Thomas J, Ramadan HH. Bacterial biofilms in surgical specimens of patients with chronic rhinosinusitis. Laryngoscope. 2005;115:578–582
  14. Nalcaci R, Baran I. Oral malodor and removable complete dentures in the elderly. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:e5–e9
  15. Bendouah Z, Barbeau J, Hamad WA, Desrosiers M. Biofilm formation by S aureus and P aeruginosa is associated with an unfavorable evolution after surgery for chronic sinusitis and nasal polyps. J Otolaryngol Head Neck Surg. 2006;134:991–996
  16. Adachi M, Ishihara K, Abe S, Okuda K. Professional oral health care by dental hygienists reduced respiratory infections in elderly persons requiring nursing care. Int J Dent Hygiene. 2007;5:69–74
  17. Kilty SJ, Desrosiers MY. The role of bacterial biofilms and the pathophysiology of chronic rhinosinusitis. Curr Allergy Asthma Rep. 2008;8:227–233
  18. Van Delden C, Iglewski BH. Cell-to-cell signaling and Pseudomonas aeruginosa infections. Emerg Infect Dis. 1998;4:551–560
  19. Jeong JH, Lee DW, Ryu RA, Lee YS. Bacteriologic comparison of tonsil core in recurrent tonsillitis and tonsillar hypertrophy. Laryngoscope. 2007;117:2146–2151
  20. Donlan RM. Biofilm formation: A clinically relevant microbiological process. Clin Infec Dis. 2001;33:1387–1392
  21. Smith K, Hunter IS. Efficacy of common hospital biocides with biofilms of MDRO. J Med Microbiol. 2008;57:966–973
  22. Thomas JK, Forrest A, Bhavnani SM, et al. Pharmacodynamic evaluation of factors associated with the development of bacterial resistance in acutely ill patients during therapy. Antimicrob Agents Chemother. 1998;42:521–527
  23. Kollef MH. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia. JAMA. 2008;300:805–813
  24. Rodrigues RMJ. Antibiotic resistance profile of the subgingival microbiota following systemic or local tetracycline therapy. J Clin Periodontal. 2004;31:420–427
  25. Feres M. Antibiotic resistance of subgingival species during and after antibiotic therapy. J Clin Periodontal. 2002;29:724–735
  26. Kwon AS, Park GC, Ryu SY, et al. Higher biofilms formation in multidrug-resistant clinical isolates of Staphylococcus aureus. Int J Antimicrob Agents. 2008;32:68–72
  27. Martinez-Solano L, Macia MD, Fajardo A, et al. Chronic Pseudomonas aeruginosa infection in COPD. Clin Infect Dis. 2008;47:1526–1533
  28. Paju S, Scannapieco FA. Oral biofilms, perodontitis, and pulmonary infections. Oral Dis. 2007;13:508–512
  29. Russell SL, Boylan RJ, Kaslick RS, et al. Respiratory pathogen colonization of the dental plaque of institutionalized elders. Spec Care Dentist. 1999;19:128–134
  30. Finegold SM. Anaerobic bacteria: General concepts. In:  Mandell GL,  Bennett JE,  Dolin R editor. Mandell, Douglas, and Bennett's Principles and Practices of Infectious Diseases. 5th ed. Philadelphia, PA: Churchill Livingston; 2000;p. 2519–2537
  31. Shay K. Infectious complications of dental and periodontal diseases in the elderly population. Clin Infect Dis. 2002;34:1215–1223
  32. Raghavendran K, Mylotte JM, Scannapieco FA. NH associated pneumonia, hospital acquired pneumonia and VAP: The contribution of dental biofilms and periodontal inflammation. Periodontal 2000. 2007;44:164–177
  33. Palmer LB, Albulak K, Fields S, et al. Oral clearance and pathogenic oropharyngeal colonization in the elderly. Am J Respir Crit Care Med. 2001;64:464–468
  34. Dal Nogare AR, Toews GB, Pierce AK. Increased salivary elastase precedes gram-negative bacillary colonization in postoperative patients. Am Rev Respir Dis. 1987;135:671–675
  35. Estes RJ, Meduri GU. The pathogenesis of ventilator-associated pneumonia: Mechanisms of bacterial transcolonization and airway inoculation. Intensive Care Med. 1995;21:365–383
  36. Hota S, Hirji Z, Stockton K, Lemieux C. Outbreak of multidrug-resistant Pseudomonas aeruginosa colonization and infection secondary to an imperfect ICU room design. Infect Control Hosp Epidemiol. 2009;30:25–33
  37. Safdar N, Crnich CJ, Maki DG. The pathogenesis of ventilator associated pneumonia: Its relevance to developing effective strategies for prevention. Respir Care. 2005;50:725–739
  38. El-Solh AA, Pietrantoni C, Bhat A, et al. Colonization of dental plaques: A reservoir of respiratory pathogens for hospital-acquired pneumonia in institutionalized elders. Chest. 2004;126:1575–1582
  39. Terpenning MS, Taylor GW, Lopatin DE, et al. Aspiration pneumonia: Dental and oral risk factors in an older veteran population. J Am Geriatr Soc. 2001;49:557–563
  40. Munro CL, Grap MJ, Elswick RK, et al. Oral health and development of VAP. Am J Crit Care. 2006;15:453–460
  41. Koshimune S, Awano S, Gohara K, et al. Low salivary flow and volatile sulfur compounds. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:38–41
  42. Almstahl A, Wikstrom M. Microflora in oral ecosystems in subjects with hyposalivation due to medicines or of unknown origin. Oral Health Prev Dent. 2005;3:67–76
  43. La Force FM, Thompson B, Trow R. Effect of atropine on oral clearance of a radiolabeled sulfur colloid. J Lab Clin Med. 1984;104:693–697
  44. Palombini BC, Villanova CA, Araujo E, et al. A pathogenic triad in chronic cough: Asthma, postnasal drip syndrome, and gastroesophageal reflux disease. Chest. 1999;116:279–284
  45. Pratter MR. Chronic upper airway cough syndrome secondary to rhinosinus diseases: ACCP evidenced based clinical practice guideline. Chest. 2006;129:63S–71S
  46. Holzapfel L, Chastang C, Demingeon G, et al. A randomized study assessing the systematic search for maxillary sinusitis in nasotracheally mechanically ventilated patients. Influence of nosocomial maxillary sinusitis on the occurrence of ventilator-associated pneumonia. Am J Respir Crit Care Med. 1999;159:695–701
  47. Rouby JJ, Laurent P, Gosnach M, et al. Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill. Am J Respir Crit Care Med. 1994;150:776–783
  48. Desmond P, Raman R, Idikula J. Effect of nasogastric tubes on the nose and maxillary sinus. Crit Care Med. 1991;19:509–511
  49. Slavin RG, Spector SL, Bernstein IL. Sinusitis Update Workgroup, Joint Task Force Reviewers. The diagnosis and management of sinusitis: A practice parameter update. J Allergy Clin Immunol. 2005;116:S13–S47
  50. Yoneyama T, Yoshida M, Ohrui T, et al. Members of the Oral Care Working Group Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc. 2002;50:430–433
  51. Bassim CW, Gibson G, Ward T, et al. Modification of the mortality risk of pneumonia with oral hygiene. J Am Geriatr Soc. 2008;56:1601–1607
  52. Kugel G, Boghosian AA. Effects of the sonicare toothbrush for specific indications. Compend Contin Educ Dent. 2002;23:11–14
  53. Shyama M, Honkala E, Honkala S, Al-Mutawa SA. Effect of xylitol candies on plaque and gingival indices in physically disabled school pupils. J Clin Dent. 2006;17:17–21
  54. Makinen KK, Pemberton D, Makinen PL, et al. Polyol-combinant saliva stimulants and oral health in VA patients. Spec Care Dentist. 1996;16:104–115
  55. Simons D, Brailsford SR, Kidd EAM, Beighton D. The effect of medicated chewing gums on oral health in frail older people: A 1-yr clinical trial. J Am Geriatr Soc. 2002;50:1348–1353
  56. De Riso AJ, Ladowski JS, Dillon TA, et al. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest. 1996;109:1556–1561
  57. Chan EY, Ruest A, Meade MO, Cook DJ. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: Systematic review and meta-analysis. BMJ. 2007;334:889–893
  58. Centers for Disease Control and Prevention. Guidelines for prevention of nosocomial pneumonia. MMWR Morbid Mortal Wkly Rep. 2004;53:1–36
  59. Robins J, Kays S, Gangnon R, Hewitt A, et al. The effects of lingual exercise on stroke patients with dysphagia. Arch Phys Med Rehab. 2007;88:150–158
  60. Ebihara S, Hiroshi S, Kanda A, et al. Impaired efficacy of cough in patients with Parkinson disease. Chest. 2003;124:1009–1015
  61. Sekizawa K, Ujiie Y, Itabashi S, et al. Lack of cough reflex in aspiration pneumonia. [letter] Lancet. 1990;335:1228–1229
  62. He M, Ohrui T, Azumi M, et al. Depressed involuntary swallowing and risk of pneumonia. J Am Geriatr Soc. 2004;52:1032–1033
  63. Yamanda S, Ebihara S, Ebihara T, et al. Impaired urge-to-cough in elderly patients with aspiration pneumonia. Cough. 2008;4:11–15
  64. Widdicombe J, Singh V. Physiological and pathophysiological down-regulation of cough. Respir Physiol Neurobiol. 2006;150:105–117
  65. Salam A, Tillukdharry L, Amoateng-Adjepong Y, Manthous CA. Neurologic status, cough, secretions, and extubation status. Intensive Care Med. 2004;30:2231–2237
  66. Logemann JI, Gensler G, Robbins J, et al. A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson's. Res. 2008;51:173–183
  67. Bulow M, Olsson R, Ekberg O. Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in healthy volunteers. Dysphagia. 1999;14:67–72
  68. Robins J, Gensler G, Hind J, et al. Comparison of two interventions for liquid aspiration pneumonia incidence. Ann Intern Med. 2008;148:509–518
  69. Campbell-Taylor I. Oral pharyngeal dysphagia in LTC: Misperceptions of treatment efficacy. J Am Med Dir Assoc. 2008;9:523–531
  70. Diagnosis and treatment of swallowing disorders (dysphagia) in acute-care stroke patients. Summary, evidence report/technology assessment: Number 8, March 1999. Available at http://www.ahrq.gov/clinic/epcsums/dysphasum.htmAccessed February 22, 2005
  71. Pick N, McDonald A, Bennett N, et al. Pulmonary aspiration in a long-term care setting: Clinical and laboratory observations and an analysis of risk factors. J Am Geriatr Soc. 1996;44:763–768
  72. Dezfulian C, Shojania K, Collard HR, et al. Subglottic secretion drainage for preventing ventilator-associated pneumonia: A meta-analysis. Am J Med. 2005;118:11–18
  73. Delaney A, Gray H, Laupland KB, Zuege DJ. Kinetic bed therapy to prevent nosocomial pneumonia in mechanically ventilated patients: A systematic review and meta-analysis. Crit Care. 2006;10:R70
  74. Mundy LM, Leet TL, Darst K, et al. Early mobilization of patients hospitalized with community-acquired pneumonia. Chest. 2003;124:883–889
  75. El Solh AA, Saliba R. Pharmacologic prevention of aspiration pneumonia. Am J Geriatr Pharmacother. 2007;5:352–362
  76. Ohkubo T, Chapman N, Neal B, et al. Perindopril Protection Against Recurrent Stroke Study Collaborative Group Effects of an angiotensin-converting enzyme inhibitor-based regimen on pneumonia risk. Am J Respir Crit Care Med. 2004;169:1041–1045
  77. Irwin RS. Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical practice guidelines. Chest. 2006;129:80S–94S
  78. Terada K. Impact of GERD symptoms on COPD exacerbation. Thorax. 2008;63:951–955
  79. Rantanen TK, Salo JA. Gastroesophageal reflux disease as a cause of death: Analysis of fatal cases under conservative treatment. Scand J Gastroenterol. 1999;34:229–233
  80. Garrouste-Orgeas M, Chevret S, Arlet G, et al. Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients. Am J Respir Crit Care Med. 1997;156:1647–1655
  81. Tamhankar AP, Peters JH, Portale G, et al. Omeprazole does not reduce gastroesophageal reflux: New insights using multichannel intraluminal impedance technology. J Gastrointest Surg. 2004;8:890–898
  82. Vela MF, Camacho-Lobato L, Srinivasan R, et al. Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: Effect of omeprazole. Gastroenterology. 2001;120:1599–1606
  83. Bonten MJM, Gaillard CA, Ven Der Geest S, et al. The role of intragastric acidity and stress ulcer prophylaxis on colonization and infection in mechanically ventilated ICU patients. Am J Respir Crit Care Med. 1995;152:1825–1834
  84. Thorens J, Froehlich F, Schwizer W, et al. Bacterial overgrowth during treatment with omeprazole compared with cimetidine: A prospective randomised double blind study. Gut. 1996;39:54–59
  85. Sanduleanu S, Jonkers D, de Bruine A, et al. Non-Helicobacter pylori bacterial flora during acid-suppressive therapy: Differential findings in gastric juice and gastric mucosa. Aliment Pharmacol Ther. 2001;15:379–388
  86. Laheij RJF, Sturkenboom MCJM, Hassing RJ, et al. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA. 2004;292:1955–1960
  87. Segal R, Dan M, Pogoreliuf I, Liebovitz A. Pathogenic colonization of the stomach in enterally fed elderly patients. J Am Geriatr Soc. 2006;54:1905–1908
  88. El-Solh AA, Pietrantoni C, Bhat A, et al. Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med. 2003;167:1650–1654
  89. el Moussaoui R, de Borgie CAJM, van den Broak P, et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: Randomized, double blind study. BMJ. 2006;332:1355–1362
  90. Micek ST, Ward S, Fraser VJ, Kollef MH. A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia. Chest. 2004;125:1791–1799
  91. Shing-Shing Y, Blackwood K, Schuster MW. The cytokine basis of cachexia and its treatment: Are they ready for prime time?. J Am Med Dir Assoc. 2008;10:219–236
  92. Patrick A, Epstein O. Review Article: Gastroparesis. Aliment Pharmacol Ther. 2008;27:724–740
  93. Youle MS, Read NW. Effect of painless rectal distension on GI transit on a solid meal. Dig Dis Sci. 1984;29:902–906
  94. Coremans G, Geypens B, Vos R, et al. Influence of continuous isobaric distension on gastric emptying and small bowel transit in young healthy women. Neurogastroenterol Motil. 2004;16:107–111
  95. Nguyen NQ, Fraser RJ, Bryant LK, et al. Diminished functional association between proximal and distal gastric motility in critically ill patients. Intensive Care Med. 2008;34:1246–1255
  96. Pilotto A, Franceschi M, Leandro G, et al. Clinical features of reflux esophagitis in older people: A study of 840 consecutive patients. J Am Geriatr Soc. 2006;54:1537–1542
  97. Drakulovic MB, Torres A, Bauer TT, et al. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: A randomised trial. Lancet. 1999;354:1851–1858
  98. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;117:388–416
  99. Peterson M, Schwab W, McCutcheon K, et al. Effects of elevating the head of the bed on interface pressure in volunteers. Crit Care Med. 2008;36:3038–3042
  100. Coffin SE, Klompas M, Classen D, Arias KM. Strategies to prevent VAP in acute care hospitals: SHAE/IDSA Practice recommendation. Infect Control Hosp Epidemiol. 2008;29:S31–40
  101. Matsui T, Yamaya M, Ohrui T, et al. Sitting position to prevent aspiration in bed-bound patients. [letter] J Am Geriatr Soc. 2007;55:142–144
  102. He M, Ohrui T, Ebihara T, et al. Pneumonia Prevention Study Group Mosapride citrate prolongs survival in stroke patients with gastrostomy. J Am Geriatr Soc. 2007;55:142–144
  103. Sokoloff L, Pavlakovic R. Neuroleptic-induced dysphagia. Dysphagia. 1997;12:177–179
  104. Food and Drug Administration. Public Health Advisory. Available at: www.fda.gov/cder/drug/advisory/antipsychotics.htm. Accessed July 14, 2005.
  105. Knol W, van Marum RJ, Jansen PAF, et al. Antipsychotic drug use and risk of pneumonia in elderly people. J Am Geriatr Soc. 2008;56:661–666
  106. Setoguchi S. Potential causes of higher mortality in elderly users of conventional and atypical antipsychotic medication. J Am Geriatr Soc. 2008;56:1644–1650
  107. Vergis EN, Brennen C, Wagener M, Muder RR. Pneumonia in long-term care: A prospective case-control study of risk factors and impact on survival. Arch Intern Med. 2001;161:2378–2381
  108. Marrie TJ. Pneumonia in the long-term care facility. Infect Control Hosp Epidemiol. 2002;23:159–164
  109. Baydarian M, Walter RN. Bronchiectasis: Introduction, etiology, and clinical features. Dis Mon. 2008;54:516–526
  110. O'Brien Guest PJ, Hill SL, Stockley RA. Physiological and radiological characterization of patients diagnosed with COPD in primary care. Thorax. 2000;55:635–642

PII: S1525-8610(09)00113-3

doi: 10.1016/j.jamda.2009.03.020

JAMDA
Volume 11, Issue 1 , Pages 70-77 , January 2010