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Biofilm formation on three different endotracheal tubes: A prospective clinical trial
Hulda Rosa Thorarinsdottir
Lunds Universitet
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5725-834X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Critical Care.
Background: 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.
Methods: 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 > 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.
Results: 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.
Conclusion: 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.
Trial registration: ClinicalTrials.gov, NCT02284438. Retrospectively registered on 21 October 2014, URL: https://clinicaltrials.gov/ct2/show/NCT02284438.
Keywords
intubation, intratracheal, biofilm, critical illness, silicones, polyvinyl chloride, alloys, pneumonia, ventilator-associated
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CURRENT STATUS: Published
Version 4
Posted 12 Jun, 2020
Published
On 29 Jun, 2020
No community comments so far
Editorial decision: Accept
On 10 Jun, 2020
Editor assigned
On 09 Jun, 2020
Submission checks complete
On 08 Jun, 2020
Editor invited
On 08 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 03 Jun, 2020
Review #2 received
Received 27 May, 2020
Review #1 received
Received 27 May, 2020
Reviewer #1 agreed
On 26 May, 2020
Reviewer #2 agreed
On 26 May, 2020
Editor assigned
On 25 May, 2020
Reviewers invited
Invitations sent on 25 May, 2020
Submission checks complete
On 24 May, 2020
Editor invited
On 24 May, 2020
No comments provided
Editorial decision: Major revision
On 09 May, 2020
Review #2 received
Received 01 May, 2020
Review #1 received
Received 01 May, 2020
Reviewers invited
Invitations sent on 30 Apr, 2020
Reviewer #1 agreed
On 30 Apr, 2020
Reviewer #2 agreed
On 30 Apr, 2020
Editor assigned
On 29 Apr, 2020
Submission checks complete
On 28 Apr, 2020
Editor invited
On 28 Apr, 2020
No comments provided
Editorial decision: Major revision
On 09 Apr, 2020
Review #3 received
Received 08 Apr, 2020
Review #1 received
Received 25 Mar, 2020
Review #2 received
Received 25 Mar, 2020
Reviewer #3 agreed
On 18 Mar, 2020
Reviewer #2 agreed
On 17 Mar, 2020
Reviewers invited
Invitations sent on 16 Mar, 2020
Reviewer #1 agreed
On 16 Mar, 2020
Editor assigned
On 13 Mar, 2020
Editor invited
On 12 Mar, 2020
Submission checks complete
On 11 Mar, 2020
First submitted
On 09 Mar, 2020
Metrics
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PDF Downloads: ...
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Subject Areas
Critical Care & Emergency Medicine
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This preprint is under consideration at Critical Care. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Biofilm formation on three different endotracheal tubes: A prospective clinical trial
Hulda Rosa Thorarinsdottir
Lunds Universitet
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5725-834X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 4
Posted 12 Jun, 2020
Published
On 29 Jun, 2020
No community comments so far
Editorial decision: Accept
On 10 Jun, 2020
Editor assigned
On 09 Jun, 2020
Submission checks complete
On 08 Jun, 2020
Editor invited
On 08 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 03 Jun, 2020
Review #2 received
Received 27 May, 2020
Review #1 received
Received 27 May, 2020
Reviewer #1 agreed
On 26 May, 2020
Reviewer #2 agreed
On 26 May, 2020
Editor assigned
On 25 May, 2020
Reviewers invited
Invitations sent on 25 May, 2020
Submission checks complete
On 24 May, 2020
Editor invited
On 24 May, 2020
No comments provided
Editorial decision: Major revision
On 09 May, 2020
Review #2 received
Received 01 May, 2020
Review #1 received
Received 01 May, 2020
Reviewers invited
Invitations sent on 30 Apr, 2020
Reviewer #1 agreed
On 30 Apr, 2020
Reviewer #2 agreed
On 30 Apr, 2020
Editor assigned
On 29 Apr, 2020
Submission checks complete
On 28 Apr, 2020
Editor invited
On 28 Apr, 2020
No comments provided
Editorial decision: Major revision
On 09 Apr, 2020
Review #3 received
Received 08 Apr, 2020
Review #1 received
Received 25 Mar, 2020
Review #2 received
Received 25 Mar, 2020
Reviewer #3 agreed
On 18 Mar, 2020
Reviewer #2 agreed
On 17 Mar, 2020
Reviewers invited
Invitations sent on 16 Mar, 2020
Reviewer #1 agreed
On 16 Mar, 2020
Editor assigned
On 13 Mar, 2020
Editor invited
On 12 Mar, 2020
Submission checks complete
On 11 Mar, 2020
First submitted
On 09 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Critical Care.
Background: 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.
Methods: 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 > 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.
Results: 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.
Conclusion: 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.
Trial registration: ClinicalTrials.gov, NCT02284438. Retrospectively registered on 21 October 2014, URL: https://clinicaltrials.gov/ct2/show/NCT02284438.
Figure 1
Figure 2