Frequency of isolation of nosocomial pneumonia pathogens from the respiratory tract of cardiac surgery hospital patients who are under extended artificial lung ventilation and efficiency of oral cavity sanitation with chlorhexidine solution

Abstract

Objective. To assess the frequency and degree of bacterial contamination of the respiratory tract in patients of cardiac surgery hospital, who are on prolonged mechanical ventilation, and to evaluate the efficiency of sanitation of the oral cavity with a solution of chlorhexidine.

Materials and methods. A comparative analysis of the oral and tracheobronchial tract microbiota in operated patients of cardiac surgery hospital undergoing prolonged (48–72 hours) artificial lung ventilation (ALV) was carried out. Microbiological assessment of the effectiveness of the oral cavity sanation with 0.1 % aqueous chlorhexidine solution is given.

Results. The oral and tracheobronchial microbiota of cardiac surgery patients undergoing prolonged ALV are represented by gram-positive (S. epidermidis) and gram-negative (K. pneumoniae, P. aeruginosa, A. baumannii) microorganisms as well as Candida fungi. It was found out that the indices of the frequency and intensity of microbial isolation from the samples of the lower parts of the respiratory tract content were comparable with those of the oral cavity. The exception was S. epidermidis, the number of which in the lower airways compared to the upper ones was low. There was a statistically significant decrease in the intensity of microbial contamination of the oral cavity in patients on ALV after the sanation procedure with an aqueous chlorhexidine solution.

Conclusions. Frequency and intensity indices of opportunistic microorganisms (K. pneumoniae, P. aeruginosa, A. inaumannii, Candida fungi) isolation from the oral cavity and lower respiratory tract in patients of cardiac surgical hospital under prolonged ALV have no statistically significant differences. The exception is S. epidermidis, whose numbers in the lower airways are low compared to the upper ones. The microbiological effectiveness of 0.1 % aqueous chlorhexidine solution in the process of sanitation of the oral cavity in patients on prolonged ALV has been established.

Keywords

Cardiac surgery hospital / prolonged artificial lung ventilation / oral and tracheobronchial microbiota / oral sanitation with chlorhexidine solution

References

[1] Nosocomial pneumonia in adults. Russian national recommendations. 2-e izdanie, pererabotannoe i dopolnennoe. Pod redaktsiey akademika RAN B.R. Gel'fanda. Moscow 2016; 176 (in Russian).

[2] Нозокомиальная пневмония у взрослых. Российские национальные рекомендации. 2-е изд., перераб. и доп. Под ред. академика РАН Б.Р. Гельфанда. М. 2016; 176.

[3] Ding С., Zhang Y., Yang Z. et al. Incidence, temporal trend and factors associated with ventilator-associated pneumonia in mainland China: a systematic review and meta-analysis. BMC Infect. Dis. 2017; 17 (1): 468. DOI: 10.1186/s12879-017-2566-2567.

[4] Chan E.Y. Oral decontamination for ventilator-associated pneumonia prevention. Aust Crit Care Off J Confed Aust Crit Care Nurses. 2009; 22 (1): 3–4.

[5] Chan EY. Oral decontamination for ventilator-associated pneumonia prevention. Aust Crit Care Off J Confed Aust Crit Care Nurses. 2009; 22 (1): 3–4.

[6] Segal L.N., Alekseyenko A.V., Clemente J.C. et al. Enrichment of lung microbiome with supraglottic taxa is associated with increased pulmonary inflammation. Microbiome 2013; 1: 19. DOI: 10.1186/2049-2618-1-19.

[7] Segal L.N., Alekseyenko A.V., Clemente J.C. et al. Enrichment of lung microbiome with supraglottic taxa is associated with increased pulmonary inflammation. Microbiome. 2013; 1: 19. DOI: 10.1186/2049-2618-1-19.

[8] Charlson E.S., Bittinger K., Haas A.R. et al. Topographical continuity of bacterial populations in the healthy human respiratory tract. Am J Respir Crit Care Med. 2011; 184 (8): 957–63. DOI: 10.1164/rccm.201104-0655OC.

[9] Goldman D.L., Chen Z., Shankar V. Lower airway microbiota and mycobiota in children with severe asthma. J Allergy Clin Immunol. 2018; 141 (2): 808–811. DOI: 10.1016/j.jaci.2017.09.018.

[10] GOST Р 52623.3-2015. Technologies for performing simple medical services. Nursing manipulations. Moscow 2015 (in Russian).

[11] ГОСТР 52623.3-2015. Технологии выполнения простых медицинских услуг. Манипуляции сестринского ухода. М. 2015.

[12] Ignatenko O.V., Bykov A.O., Tyurin I.N., Gelfand E.B., Protsenko D.N. The efficacy of VAP prophylaxis bundle. Vestnik intensivnoi terapii imeni A.I. Saltanova 2018; 3: 39–45. DOI: 0.21320/1818-474X-2018-3-39-45 (in Russian).

[13] Игнатенко О.В., Быков А.О., Тюрин И.Н. и др. Оценка эффективности протокола профилактики развития нозокомиальной пневмонии, связанной с искусственной вентиляцией легких. Вестник интенсивной терапии имени А.И. Салтанова. 2018; 3: 39–45. DOI: 0.21320/1818-474X-2018-3-39-45.

[14] MU 4.2.2039-05. Technique for collecting and transporting biomaterials to microbiological laboratories. Utv. Glavnym gosudarstvennym sanitarnym vrachom RF ot 23.12.2005. Moscow 2005 (in Russian).

[15] МУ 4.2.2039-05 «Техника сбора и транспортирования биоматериалов в микробиологические лаборатории». Утв. Главным государственным санитарным врачом РФ от 23.12.2005. М. 2005.

[16] Dobrynin V.M., Kargal'tseva N.M., Dobrynina I.A. Microbiological diagnosis of purulent-septic infections. Rekomendatsii dlya vrachey Sankt-Peterburg. Saint-Petersburg 1996 (in Russian).

[17] Добрынин В.М., Каргальцева Н.М., Добрынина И.А. Микробиологическая диагностика гнойно-септических инфекций. Рекомендации для врачей Санкт-Петербурга СПб. 1996.

[18] Mahul P., Auboyer C., Jospe R. et al. Prevention of nosocomialpneumonia in intubated patients: respective role of mechanicalsubglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Med 1992; 18: 20–25. DOI: 10.1007/BF01706421.

[19] Mahul P., Auboyer C., Jospe R. et al. Prevention of nosocomialpneumonia in intubated patients: respective role of mechanicalsubglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Med. 1992; 18: 20–25. DOI: 10.1007/BF01706421

RIGHTS & PERMISSIONS

Kudryavtseva L.G., Sergevnin V.I., Pegushina O.G., Krasotkin A.V., Vorobyova M.M.