Avaliação da alteração da microbiota bucal de pacientes internados em unidade de terapia intensiva

Abstract

In the Intensive Care Unit (ICU), the oral microbiota of patients using orotracheal intubation (OTI) can undergo changes and result in the presence of previously uncommon microorganisms, which may arise and cause Pneumonia Associated with Mechanical Ventilation (VAP). For this reason, the study aims to: evaluate the presence of Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Enterococcus spp. in the oral cavity of patients with OTI admitted to the ICU of the Hospital Universitário Regional dos Campos Gerais in three moments: initial - 0 hour, 48 hours and 96 hours of hospitalization and relate them to the diagnosis of VAP, in addition to comparing teeth with toothless, perform the semi-quantitative analysis of the four media used and compare them with each other; evaluate the resistance of microorganisms through antibiograms; and associate their presence with the percentage of discharge and mortality. The research is characterized as an observational, prospective and longitudinal study, conducted with a sample of 20 patients, divided into two groups: toothless and toothed, using IOT in the ICU. The biological material was collected on the back of the tongue with a sterile cytological brush, and then sown in selective culture medium: Bile esculin medium with azide for Enterococcus spp., Cetrimide medium for Pseudomonas aeruginosa, Mannitol salt for Staphylococcus aureus and MacConkey medium for Escherichia coli and Klebsiella pneumoniae. After 48 hours in the greenhouse, the media were evaluated macroscopically, through semi-quantitative analysis, and the colonial morphotypes that grew up were stored, described and listed, so that specific biochemical tests could be carried out and the bacterial species confirmed. For microorganisms growing in Bile esculin medium, catalase and 6.5% NaCl tests were performed; for those who grew in Cetrimide, the tests were for motility, oxidase, BHI broth and gelatin; microorganisms that grew in mannitol salt medium were tested with gram, catalase, oxidase, Dnase and MRVP; and those grown in MacConkey medium, the chosen tests were EPM, lysine, MIO, Simmons citrate and Rhamnose. After being identified, antimicrobial sensitivity tests were performed. The results found demonstrate that there is no significant difference between the three collection times for each of the media used and for bacterial resistance at different times when all microorganisms were evaluated together. However, the study found a significant difference in the comparison between the microbiota of toothed and toothless patients over 96 hours, between the bacterial growth score in different media and also that there is a significant association between the presence of bacteria and the death rate of the patients. intubated ICU patients. In view of the data obtained, it can be concluded that the insertion of the dental surgeon in the interdisciplinary team of the hospital units, especially the ICU, is of utmost importance to reduce the mortality rates associated with the presence of pathogenic bacteria in the oral cavity.