Potential Respiratory Pathogens in the Trachea and Nasal Mucosa of Intubated ICU Inpatients: Longitudinal Change and Relationship with Consciousness Level

Abstract

The aim of this study was to elucidate the longitudinal change of potential respiratory pathogens in the trachea and nasal mucosa of intubated intensive care unit (ICU) inpatients with neurological disorders. We focused on eight bacterial species designated “Bacteria requiring special attention” (SA), which are routinely under surveillance in the ICU of Kagawa University Hospital. Clinical data from bacterial testing of specimens from tracheal sputum or nasal mucosa swabs were analyzed. SA were detected in the trachea of 32.7% of patients on the first day of intubation. Furthermore, the detection rate of SA in the trachea increased over several days among patients in whom they were not detected on the first day. Most patients who were SA-positive in the trachea were also positive in the nasal mucosa. The rate of SA in the nasal mucosa of comatose patients was significantly higher than that in patients at other consciousness levels. It was suggested that thorough oral and/or nasal hygiene management is very important for comatose patients to reduce the risk of pneumonia.