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Cited by 910Nosocomial Infections in ICUPneumonia and Respiratory InfectionsAntibiotic Resistance in Bacteria

Changing Pharyngeal Bacterial Flora of Hospitalized Patients: Emergence of Gram-Negative Bacilli

Johanson, Waldemar G., Pierce, Alan K., Sanford, Jay P.·1969·New England Journal of Medicine
DOI 10.1056/nejm196911202812101
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Abstract

The prevalence of gram-negative bacilli among the oropharyngeal bacterial flora was low in physiologically normal subjects despite hospital exposure but rose markedly in patients with illnesses of varying severity. This increased prevalence was not correlated with antibiotic administration or inhalation therapy, was not dependent on duration of hospitalization and correlated best with the clinical severity of illness. Increased exposure to these organisms alone does not adequately explain these findings, suggesting that pharyngeal clearance mechanisms are impaired in these patients. Since most bacterial pneumonias begin with the aspiration into the lung of bacteria present in the upper respiratory tract, this alteration in the pharyngeal flora of ill patients may represent an important initial step in the pathogenesis of pneumonia due to gram-negative bacilli.

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Registry

Crossref · 10.1056/nejm196911202812101

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23 of 23 references verified0 citation errors · 0 not checkable

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  • Exposure to the hospital setting has minimal effect on the bacterial communities of the upper respiratory tract.

    “Exposure to the hospital setting has minimal effect on the bacterial communities of the upper respiratory tract”

    From The microbiome and critical illness (2016) · cites this paper as [4]

  • The change in microbiota seen in patients staying in hospital depends on the severity of their illness rather than their physical location.

    “the change in microbiota seen in patients staying in hospital depends on the severity of their illness rather than their physical location”

    From The microbiome and critical illness (2016) · cites this paper as [4]

  • In critically ill patients, healthy oral microbiota are displaced by gram-negative aerobes, including prominent members of the Proteobacteria phylum.

    “in critically ill patients, healthy oral microbiota are displaced by gram-negative aerobes (figure 1), including prominent members of the Proteobacteria phylum”

    From The microbiome and critical illness (2016) · cites this paper as [4]

  • The oropharynx in critical illness becomes overrun by potentially pathogenic bacteria, including prominent Proteobacteria such as P aeruginosa and K pneumoniae.

    “becomes overrun by potentially pathogenic bacteria, including prominent Proteobacteria, such as P aeruginosa and K pneumoniae.”

    From The microbiome and critical illness (2016) · cites this paper as [4]

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Authors
Johanson, W. G., Pierce, A. K., & Sanford, J. P.
Affiliations
The University of Texas Southwestern Medical Center (US)
ORCID
Sanford, Jay P.
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1969-11-20
Volume
281
Issue
21
Pages
1137-1140
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm196911202812101
OpenAlex
W2063516640
Cited by
910
References
23
Citations by year
2026: 2 · 2025: 6 · 2024: 8 · 2023: 11 · 2022: 8 · 2021: 11 · 2020: 19 · 2019: 6 · 2018: 11 · 2017: 5 · 2016: 7 · 2015: 15 · 2014: 9 · 2013: 7 · 2012: 12
FWCI
21.52
Type
journal article
Language
en
Open access
closed
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
Keywords
oropharyngeal flora, Gram-negative bacilli, hospitalized patients, pharyngeal clearance, aspiration pneumonia, upper respiratory tract, hospital exposure, antibiotic administration, inhalation therapy
MeSH terms
Adult, Anti-Bacterial Agents, Bacteria, Bacteriological Techniques, Hospitalization, Humans, Middle Aged, Pharynx, Pneumonia, Positive-Pressure Respiration, Time Factors

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