(1153) Oral Microbiome Changes Over Time in Hospitalized Older Adults From Skilled Nursing Facility vs Home

Introduction: Oral health status may contribute to hospital-acquired pneumonia (HAP) in older adults, especially in those admitted from a skilled nursing facility (SNF). We hypothesized that 1) the oral microbiome would alter over time during hospitalization; and 2) patients admitted from a SNF would have less oral microbial diversity compared to patients from home.

Methods: This prospective, exploratory study 1) assessed changes in the oral microbiome across hospitalization in non-ventilated older adults >/= 65 yrs; and 2) compared oral microbial diversity across hospitalization between patients admitted from a SNF versus home. Oral salivary specimens were collected at four time points during hospitalization: baseline (within 72 hrs), day 3, day 5, and day 7. Data were analyzed from 28 study completers (SNF=8; home=20) from a cohort of 46 participants. Genomic DNA was extracted from specimens for microbiome profiling using 16S rRNA sequencing. Taxonomic composition, relative abundance, and alpha diversity (Shannon Index) of bacterial communities were computed. Data were analyzed using descriptive statistics, χ² test, t-test, repeated measures mixed effects modeling, and PERMANOVA.

Results: Most patients were female (82%), white (82%), and mean age 78.9 yrs. Mean oral care completion was 0.8 times/day across hospitalization. Common oral bacterial genera were Streptococcus, Rothia, Prevotella, Veillonella, and Actinomyces, and remained stable across time, aside from an increase in Neisseria on days 5 and 7. Mean Shannon Index changed over time: 4.5, 4.7, 4.5, and 4.6 (p <.001). Patients admitted from a SNF had higher rates of cognitive impairment (p <.001), delirium (p=.004), and frailty (p=.034). SNF patients also had worse oral health status (p <.001) and less frequent oral care at baseline, day 3, and day 7 (p <.05). After adjusting for covariates, mean Shannon Index differed over time between SNF (4.3, 4.5, 4.0, and 4.0) and home groups (4.6, 4.8, 4.7, and 4.9; p<.01).

Conclusions: Patients admitted to the hospital from a SNF comprise a high-risk group for HAP that warrant special attention to oral care. Future research should explore the SNF patients’ clinical factors in relation to oral microbiome shifts and poor oral health status across hospitalization.