PMID- 30581834
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 2305-5839 (Print)
IS  - 2305-5847 (Electronic)
IS  - 2305-5839 (Linking)
VI  - 6
IP  - 21
DP  - 2018 Nov
TI  - Oropharyngeal colonization: epidemiology, treatment and ventilator-associated 
      pneumonia prevention.
PG  - 426
LID - 10.21037/atm.2018.10.17 [doi]
LID - 426
AB  - Oropharyngeal (OP) colonization and ventilator-associated pneumonia (VAP) 
      mechanisms are tightly linked. A significant within-population variation in OP 
      colonization has been described, with its composition being dependent from 
      patients' severity. For instance, healthy subjects have a very low rate in 
      Gram-negative bacteria (GNB) colonization, while its rate rises in comorbid 
      patients, reaching high proportions in ICU patients. Various factors can be put 
      forward to explain the modifications of hospital acquired OP. ICU patients might 
      suffer from underlying diseases; the gastric reflux induced by the presence of 
      nasogastric tubes and the patients' position influences OP colonization; salivary 
      composition might influence OP content, as it modulates bacterial adhesion and 
      induces reversible bacterial changes enhancing bacterial binding. The transition 
      from OP colonization to VAP has been shown in numerous studies, with the 
      digestive tract acting as a filter, or as a reservoir. Some therapies have been 
      investigated to modulate OP colonization, in order to reduce the risk for VAP. 
      Among those, mammalian antimicrobial peptides have been shown effective in 
      reducing GNB colonization in healthy subjects, but failed in preventing VAP in 
      ICU patients. The widely used chlorhexidine was tested in numerous trials. Data 
      on its efficacy are conflicting, and meta-analyses yield discordant results. 
      Above all, several drawbacks have aroused: a poor tolerance of concentrated 
      solutions; an increased risk of death in the less severe patients; and a reduced 
      susceptibility towards chlorhexidine of number of VAP pathogens. 
      Proanthocyanidins, used to prevent Escherichia coli adhesion to the urothelium, 
      have been tested in mice model of pneumonia with interesting results. Some 
      complementary data are needed before moving to clinical research. Future research 
      paths should include a reappraisal of OP colonization; finding better 
      formulations for chlorhexidine; define the best populations to target oral 
      decontamination and developing other strategies to prevent and treat OP 
      colonization.
FAU - Messika, Jonathan
AU  - Messika J
AD  - Medical-Surgical Intensive Care Unit, Hopital Louis Mourier, AP-HP, Colombes, 
      France.
AD  - Univ Paris Diderot, Sorbonne Paris Cite, IAME, UMR 1137, Paris, France.
AD  - INSERM, IAME, UMR 1137, Paris, France.
FAU - La Combe, Beatrice
AU  - La Combe B
AD  - Medical-Surgical Intensive Care Unit, Hopital Louis Mourier, AP-HP, Colombes, 
      France.
AD  - Univ Paris Diderot, Sorbonne Paris Cite, IAME, UMR 1137, Paris, France.
AD  - INSERM, IAME, UMR 1137, Paris, France.
AD  - Intensive Care Unit, Lorient Hospital, Lorient, France.
FAU - Ricard, Jean-Damien
AU  - Ricard JD
AD  - Medical-Surgical Intensive Care Unit, Hopital Louis Mourier, AP-HP, Colombes, 
      France.
AD  - Univ Paris Diderot, Sorbonne Paris Cite, IAME, UMR 1137, Paris, France.
AD  - INSERM, IAME, UMR 1137, Paris, France.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - China
TA  - Ann Transl Med
JT  - Annals of translational medicine
JID - 101617978
PMC - PMC6275415
OTO - NOTNLM
OT  - Oropharyngeal colonization
OT  - chlorhexidine
OT  - ventilator-associated pneumonia (VAP)
COIS- Conflicts of Interest: The authors have no conflicts of interest to declare.
EDAT- 2018/12/26 06:00
MHDA- 2018/12/26 06:01
PMCR- 2018/11/01
CRDT- 2018/12/25 06:00
PHST- 2018/12/25 06:00 [entrez]
PHST- 2018/12/26 06:00 [pubmed]
PHST- 2018/12/26 06:01 [medline]
PHST- 2018/11/01 00:00 [pmc-release]
AID - atm-06-21-426 [pii]
AID - 10.21037/atm.2018.10.17 [doi]
PST - ppublish
SO  - Ann Transl Med. 2018 Nov;6(21):426. doi: 10.21037/atm.2018.10.17.