Impact of oral hygiene interventions on oral flora in stroke and comatose patients at tertiary hospital, Shendi, Sudan

Background: The oral cavity hosts a diverse microbial ecosystem essential for oral health, but critically ill patients often face imbalances due to poor oral hygiene and antibiotic use. This can increase the risk of serious complications such as aspiration pneumonia and systemic infections. While the importance of oral hygiene and antibiotic management is recognized, there is a significant research gap on this issue, especially in developing countries. Aim: This study aimed to evaluate the impact of oral hygiene interventions on the oral flora of stroke and comatose patients admitted to a tertiary hospital in Shendi, Sudan. Settings and Design: A prospective observational cohort study was conducted over a 6-month period at Elmik Nimer University Hospital in Shendi, Sudan. The study included 50 adult patients admitted to the intensive care and stroke units, all of whom had been diagnosed with either a stroke or a comatose state. Materials and Methods: Researchers collected comprehensive data on various aspects such as patient characteristics, oral hygiene practices, antibiotic usage, microbial profiles, and clinical outcomes. The statistical analyses aimed to explore the relationships between oral hygiene, antibiotic use, microbial persistence, and the occurrence of complications among the patients. The Statistical Package for th Social Sciences software version 23.0 (SPSS, Chicago, IL, USA) was used to enter and analyze the data. Descriptive and inferential statistics were calculated. Results: The study examined a population consisting of 60% stroke patients and 40% comatose patients, with an average age of 65 years and a standard deviation of ±12 years. The most frequently isolated microorganisms in the study were Streptococcus mutans , Klebsiella pneumoniae , and Escherichia coli . The findings indicated that antibiotic treatment significantly decreased the persistence of these pathogens over time. In contrast, the use of mouthwash alone did not exhibit a significant effect on pathogen levels. Notably, comatose patients displayed a higher initial prevalence of K. pneumoniae compared to their stroke counterparts. The study also identified that aspiration pneumonia and systemic complications, such as sepsis, affected 10% and 14% of the patients, respectively. Furthermore, the mortality rate was observed to be higher in comatose patients at 40%, compared to 20% among stroke patients. Conclusion: The study emphasizes the importance of oral hygiene and antibiotic treatment in managing the oral microbial profiles of stroke and comatose patients. While antibiotics help reduce harmful pathogens, using mouthwash alone is inadequate for maintaining a healthy oral balance. It highlights the risk of aspiration pneumonia and systemic infections, stressing the necessity for comprehensive oral care protocols in intensive care units to prevent complications in critically ill patients.