Probiotics for Reduction of Pathogenic Bacteria in Connection With Advanced Surgery in the Mouth, the Oropharynx, and on the Neck
Longer surgical procedures require intubation and there is a potential risk of contaminating
the lower airways with pathogenic bacteria from the mouth and oropharynx.
Surgery including the mouth and the oropharynx is performed in an area that is colonised by
hundreds of different bacterial species. In the healthy person there is a balance between
the different microbes and possible pathogens are kept under control.
Patients that are subject to surgery in the mouth, oropharynx or neck area, most often have
cancer diagnoses. Preoperative treatment (mostly radiation) is done in most cases resulting
in a changed spectrum of bacteria in the mouth and oropharynx. Due to lowered appetite
increased difficulties to eat, in combination with cancer diagnosis, there is also a change
in cranial direction of the microbiological gut flora resulting in the presence of pathogens
such as Gram-negative bacteria. Those species may result in troublesome infections in the
With healthy people pathogenic bacteria originating from the gastro/intestinal canal are
seldom found in the oropharynx, but those do occur among many patients.
Antibiotics are used prophylactic and for more extensive surgery, as micro vascular
procedures with free transplants of tissues, antibiotics are kept throughout the length of
stay (LOS) in hospital. This results in an increased risk for the development of resistant
bacteria and does result in changes in the GI flora in those patients. Diarrhoea occurs
frequently and are troublesome for the patients For ICU patients we have seen a reduction of
emerging enteric bacteria in patients given oral care with probiotics and this study will
explore the possibility of the same kind of positive effects in patients due for extensive
surgery performed during several hours.
Many of the patients will have a tracheostomy performed as part of the surgical procedure.
Patients will be randomised (1:1) to either no prophylaxis (standard procedure today) or to
preparation with a probiotic suspension fro the day before surgery until discharge from
Preoperatively the patients will gurgle a suspension of probiotics and then swallow the
Postoperatively the probiotics is given enterally and a eventually when the responsible
surgeon find it suitable by mouth again.
Cultures at inclusion, after intubation, and then on predefined days postoperatively to
compare bacterial flora in the oropharynx and in tracheal secretions.
Infectious parameters will be followed.
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
Differences in pathogenic bacteria in the oropharynx
Emerging and resident bacteria will be compared for the cultures taken in the oropharynx and from tracheal secretions in connection to a surgical intervention and postoperatively
During hospitalization, anticipated mean time 12 days
Bengt Klarin, MD, PhD
Lund University Hospital
Sweden: Regional Ethical Review Board