Advanced ENT Surgery Clinical Trial
Official title:
Probiotics for Reduction of Pathogenic Bacteria in Connection With Advanced Surgery in the Mouth, the Oropharynx, and on the Neck
Surgery in the mouth and oropharynx is performed in an area colonised by bacteria
non-pathogenic and pathogenic.
Antibiotics are used regularly resulting in disturbances in the intestinal microbiological
flora and consequently diarrhoea that can be troublesome. The use of antibiotics throughout
the hospital stay for these difficult cases represent a risk of development of resistant
strains.
Most of the patients have cancer diagnoses and have radiation therapy before surgery. This
increases the risk of the patients having pathogenic bacteria normally present in the lower
GI-tract.
The investigators have shown for ICU patients that treatment with probiotics reduces the
number of emerging enteral bacteria in the oropharynx and now the investigators will perform
an adjusted procedure for patients planned for large ear, nose, and throat (ENT) surgery.
Patients will preoperatively gurgle a suspension of probiotics and then swallow the
preparation.
Postoperatively the probiotics is given enterally and a eventually by mouth again.
Cultures will be taken from the oropharynx and tracheal secretions and the results will be
compared
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
postoperative period.
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
hospital.
Preoperatively the patients will gurgle a suspension of probiotics and then swallow the
preparation.
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.
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