Oral interventions on opportunistic pathogens in patients following acute stroke

Abstract

Oral opportunistic pathogens are highly prevalent following acute stroke, and are associated with post-stroke pneumonia OBJECTIVES: Randomized clinical trial to assess the effectiveness of oral hygiene interventions (oral hygiene instruction, chlorhexidine mouthrinse, assisted brushing) on oral opportunistic pathogens including Staphylococcus aureus, aerobic and facultatively anaerobic Gram negative bacilli (AGNB), and yeasts. METHODS: 81 stroke survivors undergoing hospital-based rehabilitation were block randomized to receive either (1) oral hygiene instruction (OHI) only, (2) OHI and 0.2% chlorhexidine (CHX) mouthrinse (twice daily), or (3) OHI, 0.2% CHX mouthrinse (twice daily), and assisted brushing (twice weekly). Concentrated oral rinse and imprint samples were obtained from patients upon admission to acute stroke rehabilitation and prior to hospital discharge (3 weeks later) for detection of S. aureus, AGNB, and yeasts. Patients were monitored for development of infectious complications. AGNB were identified with API20E and API20NE. S. aureus and yeasts were identified with Staph Slidex Plus and ID32C, respectively. RESULTS: Almost three quarters (72.8%) of patients harbored oral AGNB at baseline. Over half of the patients had detectable S. aureus (56.8%) and yeasts (59.3%). Percentage frequencies and viable counts of pathogens remained relatively stable during the course of the clinical trial, and no significant differences were observed between groups. No patients developed pneumonia during the intervention period. CONCLUSION: There was no significant difference in the effectiveness of the three different oral hygiene interventions in combating oral opportunistic pathogens.