title: The use of piperacillin-tazobactam coated tympanostomy tubes against ciprofloxacin-resistant Pseudomonas biofilm formation: an in vitro study.
abstract: OBJECTIVE
  Bacterial biofilm formation has been implicated in the high rate of persistent otorrhea after tympanostomy tube insertion. It has been suggested that the tube material may be an important factor in the development of otorrhea. Recently we reported the presence of ciprofloxacin-resistant Pseudomonas aeruginosa (CRPA) biofilms on infected tympanostomy tubes following the use of intractable post-tympanostomy tubes and the onset of otorrhea. In this study, we have evaluated the resistance of piperacillin-tazobactam coated with chitosan on a tympanostomy tube to prevent CRPA biofilm formation in vitro.
  
  
  METHODS
  Three sets each of piperacillin-tazobactam coated silicone tubes (n=5), commercial silver-oxide coated silicone tubes (Activent, Silic) (n=5) and control uncoated tympanostomy tubes (Paparella type 1) (n=5) were processed for evaluation. The piperacillin-tazobactam coated tympanostomy tubes were compared with the silver-oxide coated tubes and the uncoated control tubes for resistance to CRPA biofilm formation after in vitro incubation.
  
  
  RESULTS
  Scanning electron microscopy showed that the surface of the silver-oxide coated tube (Activent) formed a thick biofilm with crusts as well as an uncoated tube. In contrast, the surface of a piperacillin-tazobactam coated tympanostomy tube showed virtually no CRPA biofilm formation.
  
  
  CONCLUSIONS
  The piperacillin-tazobactam coated tympanostomy tube showed resistance to CRPA biofilm formation. The piperacillin-tazobactam coating may be useful to reduce CRPA biofilm formation; however, further in vivo studies are necessary.
authors.affiliation: Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea. chulsavio@hanmail.net
authors.forename: Chul Ho
authors.initials: CH
authors.lastname: Jang
authors.forename: Haekyun
authors.initials: H
authors.lastname: Park
authors.forename: Yong Bum
authors.initials: YB
authors.lastname: Cho
authors.forename: Cheol Hee
authors.initials: CH
authors.lastname: Choi
authors.forename: Il Yong
authors.initials: IY
authors.lastname: Park
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001422:Bacterial Adhesion / Q000187:drug effects; D001431:Bacteriological Techniques; D018441:Biofilms / Q000187:drug effects*; D002939:Ciprofloxacin / Q000378:metabolism; D020099:Coated Materials, Biocompatible / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D004866:Equipment Contamination / Q000517:prevention & control; D004867:Equipment Design; D006801:Humans; D008422:Materials Testing; D008855:Microscopy, Electron, Scanning; D008876:Middle Ear Ventilation / Q000295:instrumentation*; D010035:Otitis Media, Suppurative / Q000382:microbiology / Q000601:surgery; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D010878:Piperacillin / Q000494:pharmacology / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000517:prevention & control; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012828:Silicones; D013499:Surface Properties / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible; D012828:Silicones; D000077725:Piperacillin, Tazobactam Drug Combination; D002939:Ciprofloxacin; D010397:Penicillanic Acid; D010878:Piperacillin