Key words: pharyngeal flora, gastric flora, enteral tube feeding, elderly patients, group B streptococci (GBS)

Transcription

1 Key words: pharyngeal flora, gastric flora, enteral tube feeding, elderly patients, group B streptococci (GBS)

2 Table 1 Backgrounds of patients receiving nasogastric tube feeding Table 2 Bacteria isolated from oral cavity

3 Table 3 Relationship between bacteria isolated from gastric iuice and gastric PH Table 5 Relationship between bacteria isolated from oral cavity and activities of daily living (ADL) `1st study ` Table 4 Backgrounds of elderly patients on admission (Nasogastric tube feeding)

4 Table 6 Relationship between bacteria isolated from oral cavity and activities of daily living (ADL) `2nd study ` Fig. 1 Antibody levels to GBS (JM9) in elderly patients Table 7 Bacteria isolated from oral cavity of patients receiving nasogastric tube feeding

5 Table 8 Changes in oral microflora in patients receiving nasogastric tube feeding

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7 10 : ) Tryba M, Cook DJ : Gastric alkalinization, pneumonia, and systemic infections : The controversy. Scand J Gastroenterol 1995 ; 30 : ) Driks MR, Craven DE, Celli BR et al. : Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. N Engl J Med 1987 ; 317: ) Wilder-Smith CH, Spirig C, Krech T, Merki HS : Bactericidal factors in gastric juice. Eur 14) Casewell M, Phillips I : Food as a source of Klebsiella species for colonisation and infection of intensive care patients. J Clin Pathol 1978 ; 31 : ) Fernandez-Crehuet Navajas M, Jurado Chacon D, Guillen Solvas JF, Galvez Vargas R : Bacterial contamination of enteral feeds as a pos- sible risk of nosocomial infection. J Hosp Infect 1992 ; 21 : ) Heyland D, Bradley C, Mandell LA : Effect of acidified enteral feedings on gastric colonization in the critically ill patient. Crit Care Med 9) Hillman KM, Riordan T, O'Farrell SM, Tabaqchali S : Colonization of the gastric contents 17) Farley MM, Harvey RC, Stull T et al. : A 1992 ; 20 : in critically ill patients. Crit Cere Med 1982 ; population-based assessment of invasive disease due to group B streptococcus in nonpregnant adults. N Engl J Med 1993 ; 328: ) Verghese A, Berk SL, Boelen LJ, Smith JK : Group B streptococcal pneumonia in the elderly. Arch Intern Med 1982 ; 142: J Gastroenterol Hepatol 1992 ; 4 : in adults. Ann Intern Med 1995 ; 123: ) Jackson LA, Hilsdon R, Farley MM et al. : Risk factors for group B streptococcal disease

8 Study of Bacterial Flora in the Oral Cavity and Stomach of Elderly Patients Receiving Nasogastric Tube Feeding Toru MATSUURA1)2), Kanzo SUZUKI1), Masahiro YAMAKOSHI1), Toshinobu YAMAMOTO1) Toshiyuki YAMAMOTO1), Kazuo YOSHITOMO2), Ken TONEGAWA2), Kenji ARIGA3) & Fumitomo ODAWARA4) To investigate the significance of oropharyngeal flora and gastric flora in elderly patients receiving nasogastric tube feeding, throat secretions and gastric aspirates were cultured and the ph of the latter was measured. Of 116 bacterial isolates from throat secretions of 27 elderly patients, 30 were fl-streptococci and 28 were Pseudomonas aeruginosa. Bacteria isolated from gastric aspirates numbered 86 and 24 (27.9%) of them were the same species as those found in the throat secretions. Patients with gastric ph were below 3.5 had significantly lower concentrations of gram-negative bacilli in gastric aspirates. We also studied oropharyngeal flora in 33 elderly patients who were admitted to Nagoyashi Koseiin Geriatric Hospital. The major bacterial isolates from throat swabs of bedridden patients were gram-negative bacilli and fl-streptococci, especially group B streptococci (GBS). We measured the level of antibody to GBS in these patients. Those from whom GBS were isolated had high titers. These results suggest that in elderly patients receiving enteral (nasogastric) tube feeding, large numbers of bacteria colonize the oral cavity and stomach. The measurement of typespecific antibody to GBS may be useful in managing such patients.