Bacterial Biofilm Presence in Pediatric Tracheotomy Tubes

Perkins, Jonathan; Mouzakes, Jason; Pereira, R. G. de A.; Manning, Scott C.

doi:10.1001/archotol.130.3.339

Cited by 38 publications

(37 citation statements)

References 23 publications

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“…32 High shear forces have been shown in the literature to favor the creation of tight, rounded microcolonies of bacteria. 33 The data from this experiment, coupled with the evidence of hydrodynamic effects on biofilm formation from the literature, suggests that a closer analysis of the effects of air flow and continuous contamination on biofilm formation in ETTs is needed. The finite element model showed that regions of low wall shear (0.20 Pa) located along the lower wall of the ETT did correlate with experimental areas of higher bacterial density of P. aeruginosa.…”

Section: Discussionmentioning

confidence: 85%

Decreased <em>Pseudomonas aeruginosa</em> biofilm formation on nanomodified endotracheal tubes: a dynamic lung model

Machado¹,

Webster²

2016

IJN

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Ventilator-associated pneumonia (VAP) is a serious complication of mechanical ventilation that has been shown to be associated with increased mortality rates and medical costs in the pediatric intensive care unit. Currently, there is no cost-effective solution to the problems posed by VAP. Endotracheal tubes (ETTs) that are resistant to bacterial colonization and that inhibit biofilm formation could provide a novel solution to the problems posed by VAP. The objective of this in vitro study was to evaluate differences in the growth of Pseudomonas aeruginosa on unmodified polyvinyl chloride (PVC) ETTs and on ETTs etched with a fungal lipase, Rhizopus arrhizus , to create nanoscale surface features. These differences were evaluated using an in vitro model of the pediatric airway to simulate a ventilated patient in the pediatric intensive care unit. Each experiment was run for 24 hours and was supported by computational models of the ETT. Dynamic conditions within the ETT had an impact on the location of bacterial growth within the tube. These conditions also quantitatively affected bacterial growth especially within the areas of tube curvature. Most importantly, experiments in the in vitro model revealed a 2.7 log reduction in the number (colony forming units/mL) of P. aeruginosa on the nanoroughened ETTs compared to the untreated PVC ETTs after 24 hours. This reduction in total colony forming units/mL along the x -axis of the tube was similar to previous studies completed for Staphylococcus aureus . Thus, this dynamic study showed that lipase etching can create surface features of nanoscale roughness on PVC ETTs that decrease bacterial attachment of P. aeruginosa without the use of antibiotics and may provide clinicians with an effective and inexpensive tool to combat VAP.

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Section: Discussionmentioning

confidence: 85%

Decreased <em>Pseudomonas aeruginosa</em> biofilm formation on nanomodified endotracheal tubes: a dynamic lung model

Machado¹,

Webster²

2016

IJN

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“…Jarrett et al observed biofilm formation on tracheostomy tubes in vitro after inoculating tracheostomy tubes made of four different materials with Pseudomonas aeruginosa and Staphylococcus epidermidis. 8 Perkins et al noted an increasing density of biofilm formation as one progressed toward the tip of tracheostomy tubes obtained from nonventilated pediatric inpatients 9…”

Section: Introductionmentioning

confidence: 99%

Characterization of bacterial biofilms on tracheostomy tubes

et al. 2009

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Biofilms were present on tracheostomy tubes in greater than 90% of tracheostomy tubes collected as early as 7 days after insertion in both the inpatients and outpatients. Although a variety of bacteria were identified in the biofilm, they often appeared as discrete microcolonies that appeared to be monospecies biofilm on confocal microscopy. There was a statistically significant inverse correlation between the number of colony forming units found and frequency of inner cannula change.

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“…14,15,17,18,21 Outcomes from single-institutions may be influenced by center-specific care practices, including which children are offered tracheotomy, timing of tracheotomy, posttracheotomy discharge planning, readmission policies, and palliative care decisions. 22–27 The objectives of this study are to (1) describe the health outcomes and hospital resource use of a large, multi-institutional cohort of children after tracheotomy and (2) identify comorbid conditions and other patient characteristics that correlate with poor health outcomes and greater hospital resource use.…”

mentioning

confidence: 99%

Predictors of Clinical Outcomes and Hospital Resource Use of Children After Tracheotomy

Berry

Graham

Graham³

et al. 2009

Pediatrics

171

200

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OBJECTIVES The objectives are to describe health outcomes and hospital resource use of children after tracheotomy and identify patient characteristics that correlate with outcomes and hospital resource use. PATIENTS AND METHODS A retrospective analysis of 917 children aged 0 to 18 years undergoing tracheotomy from 36 children’s hospitals in 2002 with follow-up through 2007. Children were identified from ICD-9-CM tracheotomy procedure codes. Comorbid conditions (neurologic impairment [NI], chronic lung disease, upper airway anomaly, prematurity, and trauma) were identified with ICD-9-CM diagnostic codes. Patient characteristics were compared with in-hospital mortality, decannulation, and hospital resource use by using generalized estimating equations. RESULTS Forty-eight percent of children were ≤6 months old at tracheotomy placement. Chronic lung disease (56%), NI (48%), and upper airway anomaly (47%) were the most common underlying comorbid conditions. During hospitalization for tracheotomy placement, children with an upper airway anomaly experienced less mortality (3.3% vs 11.7%; P < .001) than children without an upper airway anomaly. Five years after tracheotomy, children with NI experienced greater mortality (8.8% vs 3.5%; P≤.01), less decannulation (5.0% vs 11.0%; P≤.01), and more total number of days in the hospital (mean [SE]: 39.5 [4.0] vs 25.6 [2.6] days; P≤.01) than children without NI. These findings remained significant (P < .01) in multivariate analysis after controlling for other significant cofactors. CONCLUSIONS Children with upper airway anomaly experienced less mortality, and children with NI experienced higher mortality rates and greater hospital resource use after tracheotomy. Additional research is needed to explore additional factors that may influence health outcomes in children with tracheotomy.

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Bacterial Biofilm Presence in Pediatric Tracheotomy Tubes

Cited by 38 publications

References 23 publications

Decreased <em>Pseudomonas aeruginosa</em> biofilm formation on nanomodified endotracheal tubes: a dynamic lung model

Decreased <em>Pseudomonas aeruginosa</em> biofilm formation on nanomodified endotracheal tubes: a dynamic lung model

Characterization of bacterial biofilms on tracheostomy tubes

Predictors of Clinical Outcomes and Hospital Resource Use of Children After Tracheotomy

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