title: Endotracheal tube: friend or foe? Bacteria, the endotracheal tube, and the impact of colonization and infection.
abstract: The microbiology of the endotracheal tube culture plays a role in diagnosing a variety of diseases in the newborn intensive care unit, including subglottic stenosis, bronchopulmonary dysplasia, and ventilator-associated pneumonia. Bacterial production of a biofilm that coats the endotracheal tube acts as a reservoir for infection, prevents eradication, and may play a role in the development of subglottic stenosis. The diagnosis of ventilator-associated pneumonia is limited by the CDC definition as well as currently available diagnostic methods. Biomarkers could aid in differentiating colonization from infection, but are not available to most clinicians. The etiology of ventilator-associated pneumonia is often polymicrobial. Failure to differentiate colonization from infection results in unnecessary prescription of antibiotics, which could contribute to antimicrobial resistance. Measures to prevent ventilator-associated pneumonia have been described, primarily in the adult population.
authors.affiliation: Division of Newborn Medicine, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY 10029, USA. kathleen.gibbs@mssm.edu
authors.forename: Kathleen
authors.initials: K
authors.lastname: Gibbs
authors.forename: Ian R
authors.initials: IR
authors.lastname: Holzman
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D001419:Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D001997:Bronchopulmonary Dysplasia / Q000209:etiology / Q000517:prevention & control; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D003948:Diagnostic Techniques, Respiratory System; D004352:Drug Resistance, Microbial; D004866:Equipment Contamination / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000458:organization & administration; D015931:Intensive Care, Neonatal / Q000379:methods; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation; D007829:Laryngostenosis / Q000209:etiology / Q000517:prevention & control; D008826:Microbial Sensitivity Tests / Q000379:methods; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents