Nutritional status and bacterial binding in the lower respiratory tract in patients with chronic tracheostomy

• Published in: Annals of internal medicine Vol. 100; no. 6; p. 795
• Main Authors: Niederman, M S, Merrill, W W, Ferranti, R D, Pagano, K M, Palmer, L B, Reynolds, H Y
• Format: Journal Article
• Language: English
• Published: United States 01.06.1984
• Subjects: Adhesiveness; Adult; Aged; Female; Health Status; Humans; Male; Middle Aged; Mouth Mucosa - microbiology; Mucous Membrane - microbiology; Neutrophils - immunology; Nutrition Disorders - etiology; Nutrition Disorders - microbiology; Nutritional Physiological Phenomena; Pseudomonas - isolation & purification; Pseudomonas aeruginosa - immunology; Respiratory System - microbiology; Trachea - microbiology; Tracheotomy - adverse effects
• ISSN: 0003-4819
• DOI: 10.7326/0003-4819-100-6-795

Patients with chronic tracheostomy often develop tracheobronchial colonization with enteric gram-negative bacilli, especially Pseudomonas aeruginosa, but pathogenic mechanisms are largely unknown. To examine this problem, we measured in-vitro bacterial adherence to airway epithelial cells from the tracheal surfaces of 15 patients with chronic tracheostomy and 18 healthy, noncolonized controls without tracheostomy. Patients with tracheostomy had more tracheal cell adherence (7.3 +/- 0.4 [SE] bacteria/cell) than controls (4.8 +/- 0.7 bacteria/cell; p = 0.008), but patients colonized by Pseudomonas species had even more binding (9.0 +/- 0.06 bacteria/cell) than those without this finding (5.8 +/- 0.8 bacteria/cell; p = 0.008). Differences between patients in lower airway cell binding of bacteria were largely related to a multifactorial assessment of patient nutritional status, the prognostic nutritional index (r = 0.67, p = 0.005). Thus, nutritional status may account in part for the common problem of tracheobronchial colonization with gram-negative bacteria in patients with chronic tracheostomy.