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* From the Department of Genetics and Microbiology (Dr. Mobbs) and the Department of Medical Microbiology (Drs. Mobbs and van Saene, and Ms. Sunderland), University of Liverpool, Liverpool, UK; and the Cardiothoracic Centre (Dr. Davies), Broad Green Hospital, Liverpool, UK.
Background: The presence of aerobic Gram-negative bacilli (AGNB) in the oropharynx can be either temporary or persistent. Prolonged colonization (ie, carriage) is distinguished from transient presence (ie, acquisition), which often occurs in healthy individuals but less frequently in those with underlying disease. Prevalence rates of up to 61.1% quoted previously for healthy individuals were obtained by using single sample surveys, which fail to differentiate acquisition from carriage.
Study objectives: To illustrate the need to distinguish carriage from acquisition in a healthy population at risk of acquisition of AGNB, and to show that although differing groups of healthy individuals may acquire oropharyngeal AGNB at differing frequencies, carriage is rare in healthy individuals.
Participants: Two oral rinses were obtained within a 2-day interval from 120 healthy individuals comprising 40 nurses, 40 students, and 40 laboratory-associated persons.
Design: Two hundred forty oral rinses were quantitatively (1:10 dilution series) cultured for AGNB by using broth enrichment.
Measurements and results: The rate of AGNB
carriage based on two consecutive samples positive for the same AGNB
was 6.6%; the rate of AGNB acquisition based on one positive
sample was 35.8%. The concentrations of all carried and acquired AGNB
were 
103 cfu/mL. AGNB acquisition was significantly higher in
students (52.5%) compared to nurses (32.5%) and laboratory-associated
persons (22.5%; p < 0.05).
Conclusion: Healthy individuals rarely carry oropharyngeal AGNB, suggesting effective oropharyngeal clearance in a healthy population predisposed to acquisition. Apparently, the oropharyngeal mucosa in healthy individuals is not receptive to adhesins of AGNB, resulting in rapid elimination of these bacteria.
Key Words: acquisition • aerobic Gram-negative bacilli • carriage • healthy individuals • multiple survey • oropharynx
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