Tracheal tube biofilm as a source of bacterial colonization of the lung

Inglis, Tim; Millar, Michael; Jones, J.G.; Robinson, D. Ashley

doi:10.1128/jcm.27.9.2014-2018.1989

Cited by 195 publications

(96 citation statements)

References 13 publications

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“…Biofilm formation has been demonstrated on the inner endotracheal tube surface of patients undergoing mechanical ventilation (44)(45)(46). This provides an ideal environment for pathogens to colonize the device.…”

Section: Measures Recommended By Some Guidelines But Not By Others Ementioning

confidence: 99%

New Issues and Controversies in the Prevention of Ventilator-associated Pneumonia

Lorente

Blot²,

Rello³

2010

Am J Respir Crit Care Med

110

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In the past 2 years, American, Canadian, and European scientific societies have published their new evidence-based guidelines for ventilator-associated pneumonia (VAP) prevention. However, these guidelines did not review some potentially useful strategies, such as the use of an endotracheal tube with an ultrathin cuff membrane, an endotracheal tube with a low-volume/low-pressure cuff, a device for continuous monitoring of the endotracheal tube cuff pressure, a device to remove biofilm from the inner site of the endotracheal tube, and saline instillation before tracheal suctioning. Only a few guidelines analyze the time of tracheostomy, and so no firm recommendations can be made regarding its importance. In addition, the guidelines diverge on the use of heat and moisture exchangers or heated humidifiers and on the use of an endotracheal tube coated with antimicrobial agents. The current review focuses on measures of VAP prevention for which there is no clear recommendation, or the use of which is controversial. A review of the literature suggests that the use of an endotracheal tube with an ultrathin and tapered-shape cuff membrane and coated in antimicrobial agents may reduce the risk of VAP. These features offer an attractive way to optimize the VAP prevention capacity of endotracheal tubes with a lumen for subglottic secretion drainage. We believe that early tracheostomy should be considered, based on the length reduction of mechanical ventilation and intensive care unit stay, reduction of mortality, and on patient comfort, although early tracheostomy has not yet been shown to favorably impact the incidence of VAP. We believed that heat and moisture exchangers should be considered based on the benefits in terms of cost savings. More research is necessary to clarify the role of continuous cuff pressure monitoring, removal of biofilm formation in the endotracheal tubes, and routine saline instillation before tracheal suctioning.

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Section: Measures Recommended By Some Guidelines But Not By Others Ementioning

confidence: 99%

New Issues and Controversies in the Prevention of Ventilator-associated Pneumonia

Lorente

Blot²,

Rello³

2010

Am J Respir Crit Care Med

110

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“…Ventilator-associated pneumonia (VAP) is a common nosocomial infection affecting mechanically ventilated patients in the intensive care unit (ICU) (ATS, 2005). Soon after intubation, the endotracheal tube (ET) is colonized by microorganisms that form a polymicrobial biofilm on its surface (Inglis et al, 1989;Bauer et al, 2002). This ET biofilm represents a persistent source of pathogens that can infect the lungs (Cairns et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

The presence of antibiotic-resistant nosocomial pathogens in endotracheal tube biofilms and corresponding surveillance cultures

et al. 2013

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Mechanically ventilated patients often develop ventilator-associated pneumonia (VAP). Soon after intubation, a mixed biofilm harboring microbial pathogens is formed on the endotracheal tube (ET). It is believed that this biofilm contributes to the development of VAP. Unfortunately, the causative agent is often not known at the time VAP is suspected, and early therapy often relies on the identification of surveillance cultures (SC). It is thus important to know whether these SC can predict the microbial flora in ET biofilms. In this study, we compare the presence of a number of antibiotic-resistant nosocomial bacteria (Enterobacter aerogenes, Escherichia coli, Micrococcus luteus, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis) and of Candida albicans in cultures from ET biofilms and SC (i.e. sputum samples, nose swabs, and throat swabs) of 20 mechanically ventilated patients. Our data indicate that there is a good correlation between the presence of (antibiotic-resistant) pathogens in ET biofilms and SC.

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“…Furthermore, ETT biofilmencased bacteria may also contribute to lower airway infection from biofilm emboli. 17,18 The numbers, type, and virulence of bacterial pathogen(s) entering the trachea, as well as host defenses, are important factors in disease progression. In addition to a wide spectrum of potential pathogens, bacterial virulence may vary within the same bacterial species.…”

Section: Pathogenesismentioning

confidence: 99%

Diagnosis of Ventilator-Associated Respiratory Infections (VARI): Microbiologic Clues for Tracheobronchitis (VAT) and Pneumonia (VAP)

Craven

Hudcova

2011

Clinics in Chest Medicine

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Tracheal tube biofilm as a source of bacterial colonization of the lung

Cited by 195 publications

References 13 publications

New Issues and Controversies in the Prevention of Ventilator-associated Pneumonia

New Issues and Controversies in the Prevention of Ventilator-associated Pneumonia

The presence of antibiotic-resistant nosocomial pathogens in endotracheal tube biofilms and corresponding surveillance cultures

Diagnosis of Ventilator-Associated Respiratory Infections (VARI): Microbiologic Clues for Tracheobronchitis (VAT) and Pneumonia (VAP)

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