title: Advanced endotracheal tube biofilm stage, not duration of intubation, is related to pneumonia.
abstract: BACKGROUND
  Biofilms are complex communities of living bacteria surrounded by a protective glycocalyx. Biofilms have been implicated in the development of infections such as dental caries and hardware infections. Biofilms form on endotracheal tubes (ETT) and can impact airway resistance. The lifecycle of a biofilm has four stages. We hypothesize that there is a relationship between the stage of biofilm on the ETT and development of pneumonia.
  
  
  METHODS
  Thirty-two ETT were analyzed for biofilms and staged. Staging was performed by a microbiologist blinded to all patient information. Data included development of pneumonia, duration of intubation, comorbidities, and microbiology. Pneumonia was defined as presence of fever, WBC >12 K or <4 K, infiltrate on chest X-ray, and purulent sputum with +lower airway culture (bronchoalveolar lavage or brush). Statistics were performed by a biostatistician; p < 0.05 defined significance.
  
  
  RESULTS
  There were 11 women and 21 men with a mean age of 50 years. Mean intensive care unit days were 13 (standard deviation ± 9.9) and mean length of intubation was 7.4 days (standard deviation ± 5.0). Half (16 of 32) the patients developed pneumonia while intubated. Eight of 10 patients with a stage IV biofilm had pneumonia. There was a relationship between increasing biofilm stage with the incidence of pneumonia (p < 0.05). Stage IV biofilms were associated with pneumonia (p < 0.02). There was no relationship to duration of intubation, patient age or hospital stay and biofilm stage.
  
  
  CONCLUSIONS
  Advanced biofilm stage (stage IV) is associated with pneumonia. Duration of intubation does not predict biofilm stage.
authors.affiliation: Department of Surgery, Suite 7300, Health Science Center South, West Virginia University, Morgantown, WV 26506, USA. awilson@hsc.wvu.edu
authors.forename: Alison
authors.initials: A
authors.lastname: Wilson
authors.forename: Dana
authors.initials: D
authors.lastname: Gray
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Karakiozis
authors.forename: John
authors.initials: J
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018407:Bacterial Physiological Phenomena; D018441:Biofilms / Q000254:growth & development*; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000209:etiology* / Q000382:microbiology; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology* / Q000382:microbiology; D013997:Time Factors; D055815:Young Adult