Description and Microbiology of Endotracheal Tube Biofilm in Mechanically Ventilated Subjects

Danin, Pierre-Éric; Girou, Emmanuelle; Legrand, Patrick; Louis, Bruno; Fodil, Rédouane; Christov, Christo; Devaquet, Jérôme; Isabey, Daniel; Brochard, Laurent

doi:10.4187/respcare.02722

Cited by 60 publications

(45 citation statements)

References 43 publications

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“…Luminal narrowing of ETTs due to the rapid accumulation of respiratory secretions has significant clinical implications including increased ventilation pressures, difficulty in weaning patients from mechanical ventilation 31 and emergence of biofilm-related infections. 11 Similar to previous studies, 28 the micropatterned surface was capable of limiting biofilm accumulation compared to a standard care device surface (Fig. S1).…”

Section: Discussionsupporting

confidence: 81%

Micropatterned Endotracheal Tubes Reduce Secretion-Related Lumen Occlusion

et al. 2016

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Tracheal intubation disrupts physiological homeostasis of secretion production and clearance, resulting in secretion accumulation within endotracheal tubes (ETTs). Novel in vitro and in vivo models were developed to specifically recapitulate the clinical manifestations of ETT occlusion. The novel Sharklet™ micropatterned ETT was evaluated, using these models, for the ability to reduce the accumulation of both bacterial biofilm and airway mucus compared to a standard care ETT. Novel ETTs with micropattern on the inner and outer surfaces were placed adjacent to standard care ETTs in in vitro biofilm and airway patency (AP) models. The primary outcome for the biofilm model was to compare commercially-available ETTs (standard care and silver-coated) to micropatterned for quantity of biofilm accumulation. The AP model's primary outcome was to evaluate accumulation of artificial airway mucus. A 24-h ovine mechanical ventilation model evaluated the primary outcome of relative quantity of airway secretion accumulation in the ETTs tested. The secondary outcome was measuring the effect of secretion accumulation in the ETTs on airway resistance. Micropatterned ETTs significantly reduced biofilm by 71% (p = 0.016) compared to smooth ETTs. Moreover, micropatterned ETTs reduced lumen occlusion, in the AP model, as measured by cross-sectional area, in distal (85%, p = 0.005), middle (84%, p = 0.001) and proximal (81%, p = 0.002) sections compared to standard care ETTs. Micropatterned ETTs reduced the volume of secretion accumulation in a sheep model of occlusion by 61% (p < 0.001) after 24 h of mechanical ventilation. Importantly, micropatterned ETTs reduced the rise in ventilation peak inspiratory pressures over time by as much as 49% (p = 0.005) compared to standard care ETTs. Micropatterned ETTs, demonstrated here to reduce bacterial contamination and mucus occlusion, will have the capacity to limit complications occurring during mechanical ventilation and ultimately improve patient care.

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Section: Discussionsupporting

confidence: 81%

Micropatterned Endotracheal Tubes Reduce Secretion-Related Lumen Occlusion

et al. 2016

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“…Biofilm infections are caused by multiple microbial species and, in general, are especially discommoding since they facilitate a means by which microbes are able to not only colonize a host tissue, but also inert objects such as surgical sutures, where they often cause chronic surgical site infections [43][44][45], orthodontic wires [46,47], urinary or urethral catheters [48][49][50], venous or vascular catheters [51,52], ureteral stents [53,54], frontal recess stents [55], biliary stents [56] and respiratory (endotracheal) tubes [57,58], among others. Biofilms also escalate the severity of infections in the respiratory tract, burns, and other open wounds, as well as virtually any other organ system [59].…”

Section: Introductionmentioning

confidence: 99%

Antibacterial activity of iron oxide, iron nitride, and tobramycin conjugated nanoparticles against Pseudomonas aeruginosa biofilms

Armijo¹,

Wawrzyniec²,

Kopciuch³

et al. 2020

J Nanobiotechnol

115

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Background: Novel methods are necessary to reduce morbidity and mortality of patients suffering from infections with Pseudomonas aeruginosa. Being the most common infectious species of the Pseudomonas genus, P. aeruginosa is the primary Gram-negative etiology responsible for nosocomial infections. Due to the ubiquity and high adaptability of this species, an effective universal treatment method for P. aeruginosa infection still eludes investigators, despite the extensive research in this area. Results:We report bacterial inhibition by iron-oxide (nominally magnetite) nanoparticles (NPs) alone, having a mean hydrodynamic diameter of ~ 16 nm, as well as alginate-capped iron-oxide NPs. Alginate capping increased the average hydrodynamic diameter to ~ 230 nm. We also investigated alginate-capped iron-oxide NP-drug conjugates, with a practically unchanged hydrodynamic diameter of ~ 232 nm. Susceptibility and minimum inhibitory concentration (MIC) of the NPs, NP-tobramycin conjugates, and tobramycin alone were determined in the PAO1 bacterial colonies. Investigations into susceptibility using the disk diffusion method were done after 3 days of biofilm growth and after 60 days of growth. MIC of all compounds of interest was determined after 60-days of growth, to ensure thorough establishment of biofilm colonies. Conclusions:Positive inhibition is reported for uncapped and alginate-capped iron-oxide NPs, and the corresponding MICs are presented. We report zero susceptibility to iron-oxide NPs capped with polyethylene glycol, suggesting that the capping agent plays a major role in enabling bactericidal ability in of the nanocomposite. Our findings suggest that the alginate-coated nanocomposites investigated in this study have the potential to overcome the bacterial biofilm barrier. Magnetic field application increases the action, likely via enhanced diffusion of the iron-oxide NPs and NP-drug conjugates through mucin and alginate barriers, which are characteristic of cystic-fibrosis respiratory infections. We demonstrate that iron-oxide NPs coated with alginate, as well as alginate-coated magnetite-tobramycin conjugates inhibit P. aeruginosa growth and biofilm formation in established colonies. We have also determined that susceptibility to tobramycin decreases for longer culture times. However, susceptibility to the iron-oxide NP © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article' s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article'

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“…The growth of biofilm on the inner surface of endotracheal tubes (ETTs) has been recognized as one of the key steps that lead to the development of ventilator-associated pneumonia (VAP). [1][2][3][4] ETTs become heavily colonized with secretions after a relatively short time compared to the average intubation time of critically ill patients, represent- ing a continuous source of bacterial exposure of the lower respiratory system. [5][6][7] SEE THE RELATED EDITORIAL ON PAGE 108 In recent years, methods have been developed to mechanically remove secretions from the inner lumen of ETTs [8][9][10] and to reduce biofilm formation by applying a variety of bactericidal or bacteriostatic agents to the surface of the ETTs through coating or intrusion techniques.…”

Section: Introductionmentioning

confidence: 99%