Changes of Oropharyngeal Flora
Changes of Oropharyngeal Flora
Hospitalised patients have in contrast to healthy people enteric pathogenic bacteria in their
 oropharynx Increased risk of pneumonia due to the pathogens in the oropharynx Probiotics can
 reduce such bacteria in intubated critically ill patients This study will use two strain of
 probiotic bacteria for half of the patients and a placebo for the rest Active arm gurgles
 with a suspension twice a day Cultures at inclusion and at set time intervals The results of
 cultures from the two groups will be compared as will the use of antibiotics
When patients are admitted to hospital some of them are already colonized in the oropharynx
 with pathogens that are normally found as commensal or possible pathogens in the
 gastrointestinal tract. This is probably a consequence of the illness that is the cause of
 their hospital admission.

 Most patients admitted to hospital are elderly. Those patients often have their natural
 functions down regulated including their ability to secure their airway from aspiration.
 Acute illness whether you are old or young leads to changes in the intestinal microbiological
 flora. Bacteria normally found in the colon or distal ileum frequently appear in the stomach
 and more alarming in the oropharynx. Weakened by the illness, acute or chronic, there is an
 increased risk of aspiration and when there are pathogenic bacteria in the oropharynx,
 aspiration is likely to induce pneumonia - health related pneumonia.

 For intubated ICU patients we have demonstrated a reduction of colonization with enteric
 bacteria by applying probiotics in the mouth.

 After a screening period to find out what groups of patients that are most vulnerable, we
 will in a randomised way give probiotics to half of the included patients and to the other
 patients only the filling material (maltodextrin).

 With this procedure our aim is to show a reduction of pathogens in the oropharynx and as a
 secondary outcome we hope to see a reduction of pneumonia.

 Samples for microbiological analysis will be taken during the first day of admission to
 hospital and then at specified intervals.
Inclusion Criteria:

 -  Admitted to hospital

 -  Anticipated length of hospital stay 3 days or more

 Exclusion Criteria:

 -  Immune insufficiency

 -  Prior participation in the study

 -  Not being able to understand study information