title: The antimicrobial effect of nitric oxide on the bacteria that cause nosocomial pneumonia in mechanically ventilated patients in the intensive care unit.
abstract: BACKGROUND
  Nosocomial pneumonia is the second most frequent nosocomial infection and the leading cause of death from hospital-acquired infection. Endogenously produced nitric oxide is an important component of the body's natural defense mechanism. Recent studies have demonstrated that exogenous gaseous nitric oxide (gNO) is bactericidal and that inhaled gNO is beneficial to bacterial clearance.
  
  
  OBJECTIVE
  Determine the antimicrobial effect of exogenous gNO in vitro against organisms from culture collections and pathogens derived from tracheal aspirates of mechanically ventilated patients with pneumonia in an intensive care unit.
  
  
  METHODS
  Using bacterial isolates in pure culture, a 0.5 McFarland standard (10(8) colony-forming-units [cfu] per mL) was prepared and further diluted to 1:1,000 with saline, to 10(5) cfu/mL. For each isolate tested, 3 mL was pipetted into each well of a 6-well plate, and placed in a specially designed incubator with compartments for both a treatment arm and a control arm. Both chambers received a continuous flow of heated, humidified gas. The treatment chamber had 200 ppm of gNO in the gas flow, which is higher than the clinically accepted concentration for gNO. Samples were drawn off at time intervals, plated onto Columbia agar base with 5% sheep blood, and placed in a traditional incubator at 35 degrees C for a minimum of 24 h. All tests were performed in duplicate. The colony-forming units were visually counted to determine percentage kill.
  
  
  RESULTS
  There was total kill (100% of all colony-forming units) of each bacterial strain subjected to the test conditions at between 2 and 6 h of exposure to 200 ppm gNO.
  
  
  CONCLUSIONS
  gNO is bactericidal against various strains of bacteria suspended in saline, including both Gram-positive and Gram-negative organisms, and those that commonly cause nosocomial pneumonia in mechanically ventilated patients. Future work should focus on developing strategies that maximize the antimicrobial effect while minimizing the effect of these same interventions on host cells.
authors.affiliation: Respiratory Services, Vancouver Coastal Health at University of British Columbia, Vancouver, British Columbia, Canada. Bevin.McMullin@vch.ca
authors.forename: Bevin B
authors.initials: BB
authors.lastname: McMullin
authors.forename: Dean R
authors.initials: DR
authors.lastname: Chittock
authors.forename: Diane L
authors.initials: DL
authors.lastname: Roscoe
authors.forename: Harjinder
authors.initials: H
authors.lastname: Garcha
authors.forename: Lexin
authors.initials: L
authors.lastname: Wang
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Miller
mesh_terms: D000280:Administration, Inhalation; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005740:Gases; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use*; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005740:Gases; D009569:Nitric Oxide