Avaliação da presença de patógenos respiratórios na microbiota oral de pacientes submetidos à ventilação mecânica em unidades de terapia intensiva

Abstract

Much has been discussed about the role of the Dentist in the multidisciplinary team of the Intensive Care Unit (ICU). Patients, especially those who use mechanical ventilation (MV), have as their common denominator the modification of the oral microbiota after admission to the ICU, where oral biofilm can serve as a reservoir for the colonization of respiratory pathogens. Thus, aspiration of oropharyngeal contents is able to contaminate the lower respiratory tract, characterizing the main etiopathogenesis of ventilator-associated pneumonia (VAP). The objective of this study was to evaluate the presence of respiratory pathogens in the oral microbiota of patients submitted to mechanical ventilation in Intensive Care Units (ICUs). A prospective observational clinical trial was conducted at the adult ICU of the Hospital Geral Waldemar de Alcântara (HGWA), where the convenience sample consisted of 58 patients who were admitted to the Hospital between April and October 2015. Patients 18 years of age or older more, under VM by orotracheal tube, without suspected or confirmed diagnosis of pneumonia were included in the study. Patients admitted to these ICUs who were already submitted to MV by orotracheal tube for more than 24 hours were excluded. Hygienization was performed according to the standard procedure of the Hospital, with 0.12% chlorhexidine digluconate in a disposable cup, every 8 hours. All patients underwent clinical assessment and microbiological tests at two times: in the first 24 hours of MV and 72 hours after the first evaluation. K. pneumoniae and P. aeruginosa were the most frequently isolated bacterial species. A percentage increase of 23.9% of the pathogens between the 1st and 2nd evaluation was observed, but did not present, however, a statistically significant difference. When comparing the use of systemic antibiotics and the presence of pathogens, it was observed that patients who used systemic antibiotics had a higher incidence of VAP-related bacteria in the dental biofilm in the 2nd evaluation, especially K. pneumoniae (p = 0.006).