Oral flora in acute stroke patients: a prospective exploratory observational study

Abstract

Objective: To describe the bacterial profile of the oral flora during the first two weeks following a stroke, examining changes in the condition of the oral cavity and infections.
Background: Dysphagia is common after a stroke and can lead to aspiration pneumonia. Oral flora changes associated with stroke have been implicated as a possible source of bacteria that can cause systemic infections.
Materials and methods: Seventy-seven participants were recruited over a period of nine months. Fifty participants had a complete set of swabs taken from four different oral sites and saliva at three time points over a 14 day period. Molecular identification of bacteria was performed on pooled DNA extracted from swabs.
Results: A total of 103 bacterial phylotypes were identified, 29 of which were not in the Human Oral Microbiome Database (HOMD). Fourteen of the twenty most common bacterial phylotypes found in the oral cavity were Streptococcal species with Streptococcus salivarius being the most common. The condition of the oral cavity worsened during the study period. Fifteen (30%) patients had at least one infection.
Conclusions: It is unknown whether the 29 phylotypes identified that were not in the HOMD indicate a particular change in the oral flora associated with stroke, or the incomplete nature of the HOMD. The Holistic and Reliable Oral Assessment Tool detailed how the condition of the oral cavity following a stroke worsened over the fourteen days in hospital. Further research is needed to explore oral care methods to improve patient safety and comfort following a stroke.