Abstract
BackgroundVentilator-associated pneumonia (VAP) is a known complication of mechanically ventilated children in the pediatric intensive care unit (PICU). Endotracheal tube (ETT) biofilms are often implicated in the development of VAP by providing a conduit for pathogens to the lower respiratory tract.MethodsA prospective cohort study from April 2010–March 2011 of children 4 weeks to 18 years of age ventilated for greater than 72 hours to determine the microbiota of ETT biofilms and tracheal aspirates.ResultsThirty-three patients were included with a mean age of 6.1 years (SD ± 5.1 years) and average length of intubation of 8.8 days (SD ± 5.0 days). Bacterial communities from tracheal aspirates and the proximal and distal ends of ETTs were determined using 16S rRNA gene libraries. Statistical analysis utilized two-part statistics and the Wilcoxon signed rank sum test for comparison of bacterial communities. Sequencing revealed a predominance of oropharyngeal microbiota including Prevotella and Streptococcus spp. Pathogenic bacterial genera including Staphylococcus, Burkholderia, Moraxella, and Haemophilus were also represented. Bacterial load was greatest at the proximal aspect of the ETT. Duration of intubation did not significantly impact bacterial load. Morisita Horn analysis across sites showed similar communities in 24/33 (72%) of patients.ConclusionsETT biofilms and tracheal aspirates of intubated patients in the PICU primarily consisted of oropharyngeal microbiota, but had a significant representation of potentially pathogenic genera. While the majority of patients had similar microbiota when comparing their ETT biofilms and tracheal aspirates, a subset of patients showed a divergence between communities that requires further investigation.
Highlights
Ventilator-associated pneumonia (VAP) is a complication of mechanical ventilation support in critically ill children and is the second most common hospital acquired infection among patients in the pediatric intensive care unit (PICU) [1]
Endotracheal tube (ETT) biofilms and tracheal aspirates of intubated patients in the PICU primarily consisted of oropharyngeal microbiota, but had a significant representation of potentially pathogenic genera
While the majority of patients had similar microbiota when comparing their ETT biofilms and tracheal aspirates, a subset of patients showed a divergence between communities that requires further investigation
Summary
Ventilator-associated pneumonia (VAP) is a complication of mechanical ventilation support in critically ill children and is the second most common hospital acquired infection among patients in the pediatric intensive care unit (PICU) [1]. It has been postulated that the presence of an endotracheal tube (ETT) contributes to the development of VAP via colonization and formation of biofilms, providing a conduit for potential pathogens to the lower respiratory tract. Further understanding of the composition of microbial communities in ETT biofilms and the timing of colonization could provide insight into mechanisms leading to VAP and creation of preventive interventions. Ventilator-associated pneumonia (VAP) is a known complication of mechanically ventilated children in the pediatric intensive care unit (PICU). Endotracheal tube (ETT) biofilms are often implicated in the development of VAP by providing a conduit for pathogens to the lower respiratory tract
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