title: Bacterial biofilm presence in pediatric tracheotomy tubes.
abstract: OBJECTIVE
  To determine whether bacterial biofilms are present on pediatric tracheotomy tubes.
  
  
  METHODS
  Prospective observational series.
  
  
  METHODS
  Eleven tracheotomy tubes removed during routine tracheotomy tube changes were analyzed for biofilm and live bacteria presence using confocal microscopy and vital stains. The external and internal surfaces of the tracheotomy tubes were studied in 3 locations: distal tip, midtracheotomy tube, and proximal opening. These data were correlated with tracheotomy site cultures and the reason for tracheotomy dependence.
  
  
  METHODS
  Microscopic images were analyzed for the presence of a biofilm (its morphological features and the presence of live and dead bacteria within the biofilm).
  
  
  RESULTS
  Of 11 tracheotomy tubes, 10 had biofilm present on the internal surface of the distal tip. Externally, at the same location, 4 tubes had biofilms. On the internal surface of the midtracheotomy site, 8 had biofilm present, whereas only 1 had a biofilm on the internal surface of the proximal tracheotomy tube site. In the distal internal tracheotomy tube site, the biofilm was confluent in 5 tubes and patchy with evidence of microcolony formation in the remaining 5 tubes. Live bacteria were present in all biofilms. Control tracheotomy tubes did not have biofilms. All tracheotomy site cultures and disease states (chronic aspiration and bronchopulmonary dysplasia) were associated with tracheotomy tube biofilms.
  
  
  CONCLUSIONS
  Bacterial biofilms containing live bacteria were demonstrated in most pediatric tracheotomy tubes, being most frequent and extensive on the internal surface of the distal tracheotomy tip.
authors.affiliation: Division of Pediatric Otolaryngology, Children's Hospital and Regional Medical Center, Seattle, WA 98105-0371, USA. jonathan.perkins@seattlechildrens.org
authors.forename: Jonathan
authors.initials: J
authors.lastname: Perkins
authors.forename: Jason
authors.initials: J
authors.lastname: Mouzakes
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Pereira
authors.forename: Scott
authors.initials: S
authors.lastname: Manning
mesh_terms: D018441:Biofilms; D002648:Child; D004396:Coloring Agents; D006801:Humans; D018613:Microscopy, Confocal; D009093:Mucus / Q000382:microbiology; D011446:Prospective Studies; D014140:Tracheotomy / Q000295:instrumentation*
chemical_list: D004396:Coloring Agents