Abstract
IntroductionBiofilm in endotracheal tubes (ETT) of ventilated patients has been suggested to play a role in the development of ventilator-associated pneumonia (VAP). Our purpose was to analyze the formation of ETT biofilm and its implication in the response and relapse of VAP.MethodsWe performed a prospective, observational study in a medical intensive care unit. Patients mechanically ventilated for more than 24 hours were consecutively included. We obtained surveillance endotracheal aspirates (ETA) twice weekly and, at extubation, ETTs were processed for microbiological assessment and scanning electron microscopy.ResultsEighty-seven percent of the patients were colonized based on ETA cultures. Biofilm was found in 95% of the ETTs. In 56% of the cases, the same microorganism grew in ETA and biofilm. In both samples the most frequent bacteria isolated were Acinetobacter baumannii and Pseudomonas aeruginosa. Nineteen percent of the patients developed VAP (N = 14), and etiology was predicted by ETA in 100% of the cases. Despite appropriate antibiotic treatment, bacteria involved in VAP were found in biofilm (50%). In this situation, microbial persistence and impaired response to treatment (treatment failure and relapse) were more frequent (100% vs 29%, P = 0.021; 57% vs 14%, P = 0.133).ConclusionsAirway bacterial colonization and biofilm formation on ETTs are early and frequent events in ventilated patients. There is microbiological continuity between airway colonization, biofilm formation and VAP development. Biofilm stands as a pathogenic mechanism for microbial persistence, and impaired response to treatment in VAP.
Highlights
Biofilm in endotracheal tubes (ETT) of ventilated patients has been suggested to play a role in the development of ventilator-associated pneumonia (VAP)
The following data were recorded in a standardized form: age and sex of the patient, Acute Physiology and Chronic Health Evaluation (APACHE) Acute Physiology and Chronic Health Evaluation II (II) score [27], cause of mechanical ventilation, duration of ventilation, maneuvers to prevent VAP, the occurrence or not of nosocomial pneumonia, together with data of pathogen isolated in respiratory samples and/or ETT biofilm, antibiotic therapy and sensitivity patterns
Among the known VAP risk factors, we found that days of mechanical ventilation and airway colonization by A. baumannii and P. aeruginosa increased the risk for late onset VAP [44,45]
Summary
Biofilm in endotracheal tubes (ETT) of ventilated patients has been suggested to play a role in the development of ventilator-associated pneumonia (VAP). Biofilms have great importance for public health because of their role in certain infectious diseases and their role in a variety of devicerelated infections [8,9,10,11,12,13,14]. In those device-related infections, biofilms have been involved in bacterial antibiotic resistance that depends on multicellular strategies [15,16]. This resistance implies, in most of the cases, the necessity of device withdrawal in order to achieve clinical and microbiological cure
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