Abstract / Summary
Oral biofilm in critically-ill patients acts as a reservoir for respiratory pathogens; its associations in older adult ICU populations including non-intubated admissions remain poorly characterised. We quantified the prevalence and admission-level factors associated with unsatisfactory oral biofilm. Cross-sectional observational study of 150 consecutive patients aged ≥ 60 years admitted to an adult ICU (tertiary hospital, Brasília, 2024). A standardised bedside oral examination was performed by two calibrated dental surgeons (median 2 days [interquartile range, IQR: 1.25–3] after ICU admission; 92.7% within 72 h; range 1–6 days) and classified biofilm adequacy, tongue coating, mucosal lesions and decayed, missing and filled teeth (DMFT). Factors independently associated with the outcome were estimated by multivariable binary logistic regression, with Firth penalisation and variance inflation factors as prespecified sensitivity analyses. Reporting followed STROBE. Median age was 75 years [IQR 68–83]; 52.0% were women; median DMFT was 22 [18–28]. Unsatisfactory oral biofilm was identified in 109/150 patients (72.7%; 95% confidence interval [CI] 64.9–79.6), with a significant tongue-coating severity gradient (Cochran-Armitage Z = 7.29, P < 0.001). Prevalence was 87.8% under mechanical ventilatory support vs. 67.0% without ( P = 0.011). In the multivariable model (6 predictors), only pulmonary cause of admission remained the strongest independent factor associated with the outcome (adjusted odds ratio [OR] 3.38; 95% CI 0.98–11.64; P = 0.053); Firth penalisation attenuated this estimate (OR 2.96; 95% CI 0.92–9.47; P = 0.067). Approximately 75% of older adult patients already have unsatisfactory oral biofilm at ICU admission. Among all clinical and care-delivery factors examined, a pulmonary cause of admission was the strongest independent factor associated with unsatisfactory oral biofilm, though with borderline statistical significance. Older adult ICU patients with pulmonary admission, altered consciousness and non-oral feeding represent a high-risk phenotype identifiable at admission and amenable to structured oral-care intensification, including mechanical toothbrushing.