Endotracheal tubes coated with antiseptics decrease bacterial colonization of the ventilator circuits, lungs, and endotracheal tube.
BACKGROUND
Formation of a bacterial biofilm within the endotracheal tube (ETT) after tracheal intubation is rapid and represents a ready source of lung bacterial colonization. The authors investigated bacterial colonization of the ventilator circuit, the ETT, and the lungs when the ETT was coated with silver-sulfadiazine and chlorhexidine in polyurethane, using no bacterial/viral filter attached to the ETT.


METHODS
Sixteen sheep were randomized into two groups. Eight sheep were intubated with a standard ETT (control group), and eight were intubated with a coated ETT (study group). Animals were mechanically ventilated for 24 h. At autopsy, the authors sampled the trachea, bronchi, lobar parenchyma, and ETT for quantitative bacterial cultures. Qualitative bacterial cultures were obtained from the filter, humidifier, inspiratory and expiratory lines, and water trap. ETTs were analyzed with light microscopy, scanning electron microscopy, and laser scanning confocal microscopy.


RESULTS
In the control group, all eight ETTs were heavily colonized (10(5)-10(8) colony-forming units [cfu]/g), forming a thick biofilm. The ventilator circuit was always colonized. Pathogenic bacteria colonized the trachea and the lungs in five of eight sheep (up to 10(9) cfu/g). In the study group, seven of eight ETTs and their ventilator circuits showed no growth, with absence of a biofilm; one ETT and the respective ventilator circuit showed low bacterial growth (10(3)-10(4) cfu/g). The trachea was colonized in three sheep, although lungs and bronchi showed no bacterial growth, except for one bronchus in one sheep.


CONCLUSIONS
Coated ETTs induced a nonsignificant reduction of the tracheal colonization, eliminated (seven of eight) or reduced (one of eight) bacterial colonization of the ETT and ventilator circuits, and prevented lung bacterial colonization.
Berra
Lorenzo
L
Pulmonary Critical Care Medicine Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
De Marchi
Lorenzo
L
Yu
Zu-Xi
ZX
Laquerriere
Patrice
P
Baccarelli
Andrea
A
Kolobow
Theodor
T
D000818:Animals; D002710:Chlorhexidine / Q000008:administration & dosage; D015169:Colony Count, Microbial / Q000706:statistics & numerical data; D004202:Disinfectants / Q000008:administration & dosage*; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008168:Lung / Q000187:drug effects* / Q000382:microbiology; D012756:Sheep; D012837:Silver Sulfadiazine / Q000008:administration & dosage; D012122:Ventilators, Mechanical / Q000009:adverse effects / Q000382:microbiology*
D004202:Disinfectants; D002710:Chlorhexidine; D012837:Silver Sulfadiazine