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Observational Study
. 2025 May 1;34(3):208-217.
doi: 10.4037/ajcc2025470.

Oral Microbiome Changes During Hospitalization in Older Adults Not Receiving Mechanical Ventilation

Kimberly Paige Rathbun  1 , Mary Lou Sole  2 , Shibu Yooseph  3 , Rui Xie  4 , Annette M Bourgault  5 , Steven Talbert  6
Affiliations
Observational Study

Oral Microbiome Changes During Hospitalization in Older Adults Not Receiving Mechanical Ventilation

Kimberly Paige Rathbun et al. Am J Crit Care. .

Abstract

Background: Oral bacteria can be pathogenic and may change during hospitalization, potentially increasing risk for complications for older adults, including residents of skilled nursing facilities (SNFs).

Objectives: To compare the oral microbiome at hospital admission by prehospital residence (SNF vs home) in older adults not receiving mechanical ventilation and to assess changes in their oral microbiome during hospitalization.

Methods: This prospective, observational study included 46 hospitalized adults (≥65 years old) not receiving mechanical ventilation, enrolled within 72 hours of hospitalization (15 admitted from SNF, 31 from home). Oral health was assessed with the Oral Health Assessment Tool at baseline and days 3, 5, and 7. Genomic DNA was extracted from unstimulated oral saliva specimens for microbiome profiling using 16S ribosomal RNA sequencing. Taxonomic composition, relative abundance, α-diversity (Shannon Index), and β-diversity (Bray-Curtis dissimilarity) of bacterial communities were determined.

Results: Most patients were female (70%) and White (74%) or Hispanic (11%). Mean age was 78.7 years. More patients admitted from SNFs than from home had cognitive impairment (P < .001), delirium (P = .01), frailty (P < .001), and comorbidities (P = .04). Patients from SNFs had more oral bacteria associated with oral disease, lower α-diversity (P < .001), and higher β-diversity (P = .01). In the 28 study completers, α-diversity altered over time (P < .001). A significant interaction was found between groups after adjusting for covariates (P < .001).

Conclusions: Hospitalized older adults admitted from SNFs experience oral microbial and oral health disparities.

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Figures

Figure 1
Figure 1
Principal coordinate analysis (PCoA) based on Bray-Curtis dissimilarity mean and variance at genus level was higher in skilled nursing facility group (n = 15) than in home group (n = 31) at baseline. For analysis of similarities, P = .01; for multivariate dispersion test, P = .009. Bray-Curtis dissimilarity measures β-diversity (microbial compositional dissimilarity between samples or groups). Values range from 0 to 1; higher values indicate greater dissimilarity.
Figure 2
Figure 2
Changes in relative abundance of oral bacterial genera during hospitalization in study completers admitted from (A) skilled nursing facilities (n = 8) and (B) home (n = 20).
Figure 3
Figure 3
Mean Shannon Index values during hospitalization significantly differed for study completers admitted from skilled nursing facilities (n = 8) and home (n = 20). Shannon Index measures α-diversity (taxa diversity within sample or group). Higher values indicate greater taxonomic diversity.
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