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Am. J. Respir. Crit. Care Med., Volume 164, Number 3, August 2001, 464-468

Oral Clearance and Pathogenic Oropharyngeal Colonization in the Elderly

LUCY B. PALMER, KIRAM ALBULAK, SUZANNE FIELDS, ANN MARIE FILKIN, SANFORD SIMON, and GERALD C. SMALDONE

Department of Medicine, Pulmonary Critical Care Division, Geriatrics Divisions, University Medical Center, and Department of Biochemistry, State University of New York at Stony Brook, Stony Brook, New York

The elderly have an increased incidence of oropharyngeal colonization with respiratory pathogens, a well-known risk factor for the development of pneumonia. Changes in the oral milieu may occur secondary to decreased salivary production and abnormalities in swallowing. These abnormalities, common in the elderly, may result in impaired clearance of organisms, allowing pathogenic colonization. To test this hypothesis, we performed a prospective cross-sectional analysis of 75 elderly institutionalized patients and measured oral clearance using 99mTc-human serum albumin (HSA) administered to the oropharynx. Oropharyngeal cultures, salivary cell populations, elastase activity, and clinical parameters were measured simultaneously. Retention of radiolabel ranged from 100% to 2.3% over 120 min of observation. Clearance in the oropharynx was significantly decreased in those patients who had oropharyngeal colonization with gram-negative bacilli (GNB), Staphylococcus aureus (SA), or yeast compared with those demonstrating normal flora by 95% confidence intervals. Decreased clearance was also seen in patients on antidepressants by 95% confidence levels. The absolute number of salivary lymphocytes/ml and buccal cells/ml was increased in colonized patients versus noncolonized persons (mean ± SEM, 128 × 103 ± 49 × 103, 25.4 ± 11.6 × 103). Elastase activity was elevated in patients who had GNB compared with patients without GNB (mean ± SEM, 10.6 nM ± 5.7, versus 2.2 nM ± 1.2, p = 0.036). We conclude that a decrease in salivary clearance of potentially pathogenic organisms may be a major risk factor for the development of colonization in the elderly.

Keywords: oral clearance; oropharyngeal colonization; bacterial colonization




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