Biofilm Formation of Clinical Klebsiella pneumoniae Strains Isolated from Tracheostomy Tubes and Their Association with Antimicrobial Resistance, Virulence and Genetic Diversity.

Dorota Ochońska,Monika Brzychczy-Włoch,Łukasz Ścibik

doi:10.3390/pathogens10101345

Dorota Ochońska, Monika Brzychczy-Włoch + Show 1 more

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https://doi.org/10.3390/pathogens10101345

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Abstract

(1) Background: Due to the commonness of tracheotomy procedures and the wide use of biomaterials in the form of tracheostomy tubes (TTs), the problem of biomaterial-associated infections (BAIs) is growing. Bacterial colonization of TTs results in the development of biofilms on the surface of biomaterials, which may contribute to the development of invasive infections in tracheostomized patients. (2) Methods: Clinical strains of K. pneumoniae, isolated from TTs, were characterized according to their ability to form biofilms, as well as their resistance to antibiotics, whether they harbored ESβL genes, the presence of selected virulence factors and genetic diversity. (3) Results: From 53 patients, K. pneumoniae were detected in 18 of the TTs examined, which constituted 34% of all analyzed biomaterials. Three of the strains (11%) were ESβL producers and all had genes encoding CTX-M-1, SHV and TEM enzymes. 44.4% of isolates were biofilm formers, SEM demonstrating that K. pneumoniae formed differential biofilms on the surface of polyethylene (PE) and polyvinyl chloride (PVC) TTs in vitro. A large range of variation in the share of fimbrial genes was observed. PFGE revealed sixteen genetically distinct profiles. (4) Conclusions: Proven susceptibility of TT biomaterials to colonization by K. pneumoniae means that the attention of research groups should be focused on achieving a better understanding of the bacterial pathogens that form biofilms on the surfaces of TTs. In addition, research efforts should be directed at the development of new biomaterials or the modification of existing materials, in order to prevent bacterial adhesion to their surfaces.

Highlights

Tracheotomy is one of the oldest and most often conducted otolaryngological surgical procedures
(4) Conclusions: Proven susceptibility of tracheostomy tubes (TTs) biomaterials to colonization by K. pneumoniae means that the attention of research groups should be focused on achieving a better understanding of the bacterial pathogens that form biofilms on the surfaces of TTs
All six OAIT patients experienced ventilator-associated pneumonia (VAP) episodes, three of them correlated with K. pneumoniae pneumonia, of which one K pneumoniae isolate showed moderate biofilm production; the other two isolates did not produce biofilm

Summary

Introduction

Tracheotomy is one of the oldest and most often conducted otolaryngological surgical procedures. It involves the creation of an opening in the front wall of the trachea so that a tracheostomy tube can be inserted into the lumen of the airways [1,2,3]. Healthcareassociated infections (HCAIs) developing in patients with tracheostomy are a significant problem for modern medicine and are much more common in this group of patients than in others. The most common infections reported among patients with tracheostomies are respiratory tract infections manifesting as ventilator-associated pneumonia (VAP), which can be expected to develop in 4–28% of patients [1,4,6,7]

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