Bacteria and granulation tissue associated with Montgomery T-tubes.
OBJECTIVE
Although complications (infection, development of granulation tissue) of silicone Montgomery T-tubes have been reported, the microbiological consequences and the origin of granulation tissue have not yet been evaluated.


METHODS
A prospective trial.


METHODS
Twenty-three Montgomery T-tubes from 10 patients were analyzed with regard to the development of granulation tissue, bacterial growth (including genotyping with polymerase chain reaction), and results of sensitivity testing. Furthermore, stent sterilization (n = 6) was investigated.


RESULTS
Granulation tissue occurred with 74% of the stents, and all specimens showed signs of infection but no foreign body reaction. The predominant organisms were Staphylococcus aureus (35%) and Pseudomonas aeruginosa (17%). The differences between groups with and without granulation tissue were significant for P aeruginosa. Polymerase chain reaction fingerprinting of the S aureus obtained from 15 stents (n = 3 patients) revealed a total of seven different genotypes. Whereas two of these patients harbored six different genotypes of S aureus, the third patient was persistently colonized by S aureus over a 15-month period with the identical genotype. Susceptibility testing showed most commonly (65%) sensitivity to a combination of amoxicillin-clavulanate and ofloxacin. After sterilization, 92% of analyzed stent segments showed no bacterial growth.


CONCLUSIONS
Granulation tissue commonly occurred next to the silicone (subglottic area, stoma) where S aureus and P aeruginosa were commonly isolated. A combination of mechanical irritation and bacterial infection seems to account for the development of granulation tissue. Polymerase chain reaction fingerprinting showed both prolonged persistence and a change of colonizing strains after multiple stent replacements. A combination of amoxicillin-clavulanate and ofloxacin is the most effective antibiotic therapy. Sterilization of the cost-intensive silicone stents is feasible, and reuse in the same patient is justifiable from economic aspects.
Schmäl
Frank
F
Department of Otolarynology, University Hospital Muenster, Germany. schmael.hno@uni-muenster.de
Fegeler
Wolfgang
W
Terpe
Hans Joachim
HJ
Hermann
Wolfgang
W
Stoll
Wolfgang
W
Becker
Karsten
K
D000328:Adult; D000368:Aged; D001419:Bacteria / Q000254:growth & development* / Q000302:isolation & purification; D002675:Child, Preschool; D020878:Device Removal; D005260:Female; D006097:Granulation Tissue / Q000382:microbiology / Q000473:pathology*; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification; D012828:Silicones; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D015607:Stents / Q000009:adverse effects*; D013242:Sterilization; D014132:Trachea / Q000382:microbiology / Q000473:pathology*
D012828:Silicones