Biofilm formation on three different endotracheal tubes: A prospective clinical trial

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background: </jats:bold>Biofilm formation on endotracheal tubes (ETTs) is an early and frequent event in mechanically ventilated patients. The biofilm is believed to act as a reservoir for infecting microorganisms and thereby contribute to development and relapses of ventilator-associated pneumonia (VAP). Once a biofilm has formed on an ETT surface, it is difficult to eradicate. This clinical study aimed to compare biofilm formation on three widely used ETTs with different surface properties and to explore factors potentially predictive of biofilm formation.<jats:bold>Methods:</jats:bold> We compared the grade of biofilm formation on ETTs made of uncoated polyvinyl chloride (PVC), silicone-coated PVC, and PVC coated with noble metals after &gt; 24 hours of mechanical ventilation in critically ill patients. The comparison was based on scanning electron microscopy of ETT surfaces, biofilm grading, surveillance and biofilm cultures, and occurrence of VAP.<jats:bold>Results: </jats:bold>High-grade (score ≥ 7) biofilm formation on the ETTs was associated with development of VAP (OR 4.17 [95% CI 1.14–15.3], p = 0.031). Compared to uncoated PVC ETTs, the silicone-coated and noble-metal-coated PVC ETTs were independently associated with reduced high-grade biofilm formation (OR 0.18 [95% CI 0.06–0.59], p = 0.005, and OR 0.34 [95% CI 0.13–0.93], p = 0.036, respectively). No significant difference was observed between silicon-coated ETTs and noble-metal-coated ETTs (OR 0.54 [95% CI 0.17–1.65], p = 0.278). In 60% of the oropharyngeal cultures and 58% of the endotracheal cultures collected at intubation, the same microorganism was found in the ETT biofilm at extubation. In patients who developed VAP, the causative microbe remained in the biofilm in 56% of cases, despite appropriate antibiotic therapy. High-grade biofilm formation on ETTs was not predicted by either colonization with common VAP pathogens in surveillance cultures or duration of invasive ventilation.<jats:bold>Conclusion: </jats:bold>High-grade biofilm formation on ETTs was associated with development of VAP. Compared to the uncoated PVC ETTs, the silicone-coated and noble-metal-coated PVC ETTs were independently associated with reduced high-grade biofilm formation. Further research on methods to prevent, monitor, and manage biofilm occurrence is needed.<jats:bold>Trial registration:</jats:bold> ClinicalTrials.gov, NCT02284438. Retrospectively registered on 21 October 2014, URL: https://clinicaltrials.gov/ct2/show/NCT02284438.</jats:p>

What is the best technic to dislodge Staphylococcus epidermidis biofilm on medical implants?

“…Endotracheal tubes are used daily for ventilation during surgery under general anesthesia but also in intensive care units for invasive ventilation. High-grade bio lm formation on an endotracheal is associated with the development of ventilator-associated pneumonia (12,53) We currently perform a study to compare the microbiote detected in bio lm that developed in vivo on endotracheal tubes and the bacteria responsible for pneumonia acquired under mechanical ventilation.…”

“…In patients undergoing mechanical ventilation, the formation of bio lm on endotracheal tubes is an early and frequent event. Moreover, high-grade bio lm formation on an endotracheal tube is associated with the development of ventilator-associated pneumonia (12).…”

Antimicrobial Coating: Tracheal Tube Application

“…Silica-coated and precious metal-coated PVC ETs were independently associated with a reduction in high-grade biofilm formation compared to uncoated PVC ETs. 69 …”

Above and beyond: biofilm and the ongoing search for strategies to reduce ventilator-associated pneumonia (VAP)

“…We read with great interest the article by Thorarinsdottir et al [1] that compared biofilm formation on three endotracheal tube (ETT) types with the finding that biofilm formation was reduced in silicone and noble-metal coated ETTs compared to uncoated ETTs. Their findings have significant implications during the current pandemic given the prolonged intubation times of COVID-19 patients and many develop superimposed pneumonias during their hospital course.…”

“…Prevention is further complicated by a reduction in host mechanisms such as coughing and mucociliary clearance. Biofilms specifically cause two primary issues: (1) non-microbiological problem of intraluminal narrowing and (2) microbiological problem of biofilm development on the inner/outer surfaces of the ETT. The latter issue relates to our current discussion here.…”