Molecular analysis of the endobronchial stent microbial biofilm reveals bacterial communities that associate with stent material and frequent fungal constituents

Abstract

Endobronchial stents are increasingly used to treat airway complications in multiple conditions including lung transplantation but little is known about the biofilms that form on these devices. We applied deep sequencing to profile luminal biofilms of 46 endobronchial stents removed from 20 subjects primarily with lung transplantation-associated airway compromise. Microbial communities were analyzed by bacterial 16S rRNA and fungal ITS marker gene sequencing. Corynebacterium was the most common bacterial taxa across biofilm communities. Clustering analysis revealed three bacterial biofilm types: one low diversity and dominated by Corynebacterium ; another was polymicrobial and characterized by Staphylococcus ; and the third was polymicrobial and associated with Pseudomonas , Streptococcus , and Prevotella . Biofilm type was significantly correlated with stent material: covered metal with the Staphylococcus -type biofilm, silicone with the Corynebacterium -dominated biofilm, and uncovered metal with the polymicrobial biofilm. Subjects with sequential stents had frequent transitions between community types. Fungal analysis found Candida was most prevalent, Aspergillus was common and highly enriched in two of three stents associated with airway anastomotic dehiscence, and fungal taxa not typically considered pathogens were highly enriched in some stents. Thus, molecular analysis revealed a complex and dynamic endobronchial stent biofilm with three bacterial types that associate with stent material, a central role for Corynebacterium , and that both expected and unexpected fungi inhabit this unique niche. The current work provides a foundation for studies to investigate the relationship between stent biofilm composition and clinical outcomes, mechanisms of biofilm establishment, and strategies for improved stent technology and use in airway compromise.

The Impact of Human Microbiotas in Hematopoietic Stem Cell and Organ Transplantation

“…Aside from fungal taxa, the existence of several bacterial taxa such as Corynebacterium (most common), Staphylococcus , Pseudomonas , Streptococcus , and Prevotella was also noted by the authors. Furthermore, some evidence indicating fungal–bacterial covariation was also observed in this study ( 230 ).…”

“…They natively colonize the human oral cavity, nasopharynx, and GI tract (227)(228)(229). In a recent study, a group applied deepsequencing to analyze the microbial biofilms present on endobronchial stents (a silicone/steel tube that keeps the bronchial tubes open in patients affected by bronchial stenosis) in a patient cohort predominantly consisting of lung transplant recipients (230). The authors reported Candida spp.…”

Impact of microbial contamination of the islet product during total pancreatectomy with islet autotransplantation

“…It is likely that sphincterotomy performed for stent placement allowed bacteria to invade the main pancreatic duct . This story mirrors that in previous studies of biofilm covering pancreatic duct stents . Taken together, such a large difference in the final product contamination rate between autologous and allogeneic cases might result from the number of bacteria and their localization and colonization.…”

Facile Modification of Medical-Grade Silicone for Antimicrobial Effectiveness and Biocompatibility: A Potential Therapeutic Strategy against Bacterial Biofilms

“…were found as well as Gm+ S. aureus and Gm− P. aeruginosa. 12 In addition to biofilms, silicone airway stents are subject to the adhesion of mucus and airway plugging. The use of 3D printing technology to make patient-specific silicone stents results in fewer AEs due to migration and reduced need for stent changes, but infections and mucus adherence are not addressed by shape.…”

“…aureus and Gm– P. aeruginosa . In addition to biofilms, silicone airway stents are subject to the adhesion of mucus and airway plugging.…”