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Biofilms and Ventilation

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The Role of Biofilms in Device-Related Infections

Part of the book series: Springer Series on Biofilms ((BIOFILMS,volume 3))

Abstract

The need for mechanical ventilation (MV) has paralleled the growth of the ICU for a ageing population with multiple disease entities, particularly those associated with pulmonary diseases. As the process of ventilation has improved, the etiology of Ventilator-Associated Pneumonia (VAP) has moved from the instrumentation to the colonization of the patient, focusing most recently on the link of normal oral flora as the initial, catalyzing insult in patients at risk for pneumonia through a biofilm in the lumen of the endotrachial tube (ETT).

The ETT, particularly the lumen, is an unrecognised reservoir for biofilms in the evolving discussion of indwelling medical device (IMD)-associated infections; yet it is the perfect environment for such communities to form. The endotrach lumen is protected from systemic therapeutic interventions. The environment is rich with the parameters associated with biofilm development.

Risk factors for ventilator-associated pneumonia and development of ETT luminal biofilms are multi-factorial including: length of hospitalization, surgery, prior antibiotic usage, stress ulcer prophylaxis, host factors such as ARDS, upper aspiratory colonization, and poor oral hygiene. The most significant risk factors, however, appear to be length of mechanical ventilation and prior exposure to antibiotic therapy.

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References

  • American Thoracic Society; Infectious Diseases Society of America (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171:388–416

    Article  Google Scholar 

  • Balaban N, Stoodley P, Fux CA, Wilson S, costerton JW, Dell’Acqua G (2005) Prevention of staphylococcal biofilm-associated infections by quorum sensing inhibitor RIP. Clin Orthop Relat Res 437:48–54

    Article  PubMed  Google Scholar 

  • Bauer TT, Torres A, Ferrer R, Heyer CM, Schultze-Werninghaus G, Rasche K (2002) Biofilm formation in endotracheal tubes: association between pneumonia and the persistence of pathogens. Monaldi Arch Chest Dis 57:84–87

    PubMed  CAS  Google Scholar 

  • Beck-Schimmer B, Madjdpour C, Kneller S, Ziegler U, Pasch T, Wuthrich RP, Ward PA, Schimmer RC (2002) Role of alveolar epithelial ICAM-1 in lipopolysaccharide-induced lung inflammation. Eur Respir J 19:1142–1150

    Article  PubMed  CAS  Google Scholar 

  • Beck-Schimmer B, Schimmer RC, Pasch T (2004) The airway compartment: chambers of secrets. News Physiol Sci 19:129–132

    PubMed  CAS  Google Scholar 

  • Bonten MJ, Kollef MH, Hall JB (2004) Risk factors for ventilator-associated pneumonia: from epidemiology to patient management. Clin Infect Dis 38:1141–1149

    Article  PubMed  Google Scholar 

  • Cason CL, Tyner T, Saunders S, Broome L (2007) Nurses’ implementation of guidelines for ventilator-associated pneumonia from the Centers for Disease Control and Prevention. Am J Crit Care 16:28–38

    PubMed  Google Scholar 

  • Charles PE, Martin L, Etienne M, Croisier D, Piroth L, Lequeu C, Pugin J, Portier H, Chavanet P (2004) Influence of positive end-expiratory pressure (PEEP) on histopathological and bactreriological aspects of pneumonia during low tidal volume mechanical ventilation. Intensive Care Med 30:2263–2270

    Article  PubMed  Google Scholar 

  • Chastre J, Fagon YT (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903

    PubMed  Google Scholar 

  • Clutterbrick A et al. (2007) Evaluating antibiotics for use in medicine using a poloxamer biofilm model. Ann. Clin. Micro. and Antimicrobials 6(2)

    Google Scholar 

  • Cook DJ, Walter SD, Cook RJ (1998) Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 129:433–440

    PubMed  CAS  Google Scholar 

  • Davis KA (2006) Ventilator-associated pneumonia: a review. J Intensive Care Med 21:211–226

    Article  PubMed  Google Scholar 

  • DeRiso AJ II, Ladowski JS, Dillon TA, Justice JW, Peterson AC (1996) Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and non-prophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 109:1556–1561

    Article  PubMed  CAS  Google Scholar 

  • Dhanireddy S, Altemeier WA, Matute-Bello G, O’Mahony DS, Glenny RW, Martin TR, Liles WC (2006) Mechanical ventilation induces inflammation, lung injury, and extra-pulmonary organ dysfunction in experimental pneumonia. Lab Invest 86:790–799

    Article  PubMed  CAS  Google Scholar 

  • Donlan RM, Costerton JW (2002) Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev 15:167–193

    Article  PubMed  CAS  Google Scholar 

  • Dupont H, Mentec H, Sollet JP, Bleichner G (2001) Impact of appropriateness of initial antibiotic therapy on the outcome of ventilator-associated pneumonia. Intensive Care Med 27:355–362

    Article  PubMed  CAS  Google Scholar 

  • Fagon JY, Rello J (2006) Targeted antibiotic management of ventilator-associated pneumonia. Clin Microbiol Infect 12(Suppl 9):S17–S22

    Article  Google Scholar 

  • Fourrier F, Cau-Pottier E, Boutigny H, Roussel-Delvallez M, Jourdain M, Chopin C (2000) Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients. Intensive Care Med 26:1239–1247

    Article  PubMed  CAS  Google Scholar 

  • Fux CA, Costerton JW, Stewart PS, Stoodley P (2005) Survival strategies of infectious biofilms. Trends Microbiol 13:34–40

    Article  PubMed  CAS  Google Scholar 

  • Gilbert P et al. (1998) The use of poloxamer hydrogels for the assessment of biofilm susceptibility towards biocide treatment. J Appl Micro 85:985–990

    CAS  Google Scholar 

  • Grap MJ, Munro CL, Elswick RK Jr, Sessler CN, Ward KR (2004) Duration of action of a single, early, oral application of chlorhexidine on oral microbial flora in mechanically ventilated patients: a pilot study. Heart Lung 33:83–91

    Article  PubMed  Google Scholar 

  • Habish M, Reid G (1999) Microbial biofilms: their development and significance for medical device-related infections. J Clin Pharmacol 39:887–898

    Article  Google Scholar 

  • Hoffken G, Niederman MS (2002) Nosocomial pneumonia: the importance of a de-escalating strategy for antibiotic treatment of pneumonia in the ICU. Chest 122:2183–2196

    Article  PubMed  Google Scholar 

  • Houston S, Hougland P, Anderson JJ, LaRocco M, Kennedy V, Gentry LO (2002) Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Am J Crit Care 11:567–570

    PubMed  Google Scholar 

  • Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH (2000) The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 118(1):146–155

    Article  PubMed  CAS  Google Scholar 

  • Imai Y, Parodo J, Kajikawa O, de Perrot M, Fischer S, Edwards V, Cutz E, Liu M, Deshavjee S, Martin TR, Marshall JC, Ranieri VM, Slutsky AS (2003) Injurious mechanical ventilation and end-rogan epithelial cell apoptosis and organ dysfunction in an experimental model of acute respiratory distress syndrome. JAMA 289:2104–2112

    Article  PubMed  Google Scholar 

  • Inglis T, Lim TM, Ng ML, Tang EK, Hui KP (1995) Structural features of tracheal tube biofilm formed during prolonged mechanical ventilation. Chest 106:1049–1052

    Article  Google Scholar 

  • Isakow W, Kollef MH (2006) Preventing ventilator-associated pneumonia; an evidence-based approach of modifiable risk factors. Semin Respir Crit Care Med 27:5–17

    Article  PubMed  Google Scholar 

  • Kollef M (2002) Ventilator-associated pneumonia and ventilator induced lung injury: two peas in a pod. Crit Care Med 30:2391–2392

    Article  PubMed  Google Scholar 

  • Kollef MH (2005) What is ventilator-associated pneumonia and why is it important? Chest 50:714–721

    Google Scholar 

  • Kollef MH (2007) Moving towards real-time antimicrobial management of ventilator-associated pneumonia. Clin Infect Dis 44:388–390. Epub 2007 Jan 3

    Article  PubMed  Google Scholar 

  • Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ, Johannes RS (2005) Epidemiology and outcomes of healthcare-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest 128:3854–3862

    Article  PubMed  Google Scholar 

  • Linden PK, Paterson DL (2006) Parenteral and inhaled colistin for treatment of ventilator-associated pneumonia. Clin Infect Dis 43(Suppl 2):S89–S94

    Article  PubMed  CAS  Google Scholar 

  • Leid JG, Wilson CJ, Shirtliff ME, Hassett DJ, Parsek MR, Jeffers AK (2005) The Exopolysaccharide alginate protects Pseudomonas aeruginosa biofilm bacteria from IFN-γ-mediated macrophage killing. J Immunol. 171:5886–5894

    Google Scholar 

  • Leone M, Garcin F, Bouvenot J, Boyadjev I, Visintini P, Albanese J, Martin C (2007) Ventilatorassociated pneumonia: breaking the vicious circle of antibiotic overuse. Crit Care Med 35(2):379–385

    Article  PubMed  Google Scholar 

  • Madjdpour C, Oertli B, Ziegler U, Bonvini JM, Pasch T, Beck-Schimmer B (2000) Lipopolysaccharide induces functional ICAM-1 expression in rat alveolar epithelial cells in vitro. Am J Physiol Lung Cell Mol Physiol 278:L572–L579

    PubMed  CAS  Google Scholar 

  • Madjdpour C, Jewell UR, Sneller S, Ziegler U, Schwendener R, Booy C, Klausli L, Pasch T, Schimmer RC, Beck-Schimmer B (2003) Decreased alveolar oxygen induces lung inflammation. Am J Physiol Lung Cell Mol Physiol 284:L360–L367

    PubMed  CAS  Google Scholar 

  • Mandell LA, Wunderlink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NG, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG (2007) Infectious disease society of America; American thoracic society guidelines for community-acquired Pneumonia in adults. Clin Infect Dis 44(Suppl 2):S27–S72

    Article  PubMed  CAS  Google Scholar 

  • Pacheco-Fowler V, Gaonkar T, Wyer PC, Modak S (2004) Antiseptic impregnated endotracheal tubes for the prevention of bacterial colonization. J Hosp Infect 57:170–174

    Article  PubMed  CAS  Google Scholar 

  • Rello J, Diaz E, Roque M, Valles J (1999) Risk factors for developing pneumonia within 48 hours of intubation. Am J Respir Crit Care Med 159:1742–1746

    PubMed  CAS  Google Scholar 

  • Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm K, Redman R, Kollef MH (2002) Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 122:2115–2121

    Article  PubMed  Google Scholar 

  • Rello J, Kollef M, Diaz E, Sandiumenge A, delCastillo Y, Corbella X, Zachskom R (2006) Reduced burden of bacterial airway colonization with a novel silver-coated endotracheal tube in a randomized multiple-center feasibility study. Crit Care Med 34:2766–2772

    Article  PubMed  Google Scholar 

  • Ruiz M, Torres A, Ewig S, Marcos MA, Alcon A, Lledo R, Asenjo MA, Maldonaldo A (2000) Noninvasive versus invasive microbial investigation in ventilator-associated pneumonia: evaluation of outcome. Am J Respir Crit Care Med 162:119–125

    PubMed  CAS  Google Scholar 

  • Sanchez-Nieto JM, Torres A, Garcia-Cordoba F, El-Ebiary M, Carrillo A, Ruiz J, Nunez ML, Niederman M (1998) Impact of invasive and noninvasive quantitative culture sampling on outcome of ventilator-associated pneumonia: a pilot study. Am J Respir Crit Care Med 157:371–376. Erratum in Am J Respir Crit Care Med 1998;157:1005

    Google Scholar 

  • Slutsky AS, Ranieri VM (2000) Mechanical ventilation: lessons from the ARDSNet trial. Respir Res 1:73–77

    Article  PubMed  CAS  Google Scholar 

  • Tablan OC, Anderson IJ, Besser R, Bridges C, Hajjeh R (2004) Guidelines for preventing healthcareassociated pneumonia, 2003: recommendations of DCD and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 53(RR-3):1–36

    PubMed  Google Scholar 

  • Zee ED, Schomberh S, Carpenter TC (2006) Hypoxia upregulates lung microvascular neurokinin-1 receptor expression. Am J Physiol Lung Cell Mol Physiol 291:L102–L110

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pathology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA

    J. G. Thomas

  2. Department of Pathology, Proteomics, West Virginia University, Morgantown, WV, 26506, USA

    L. Corum

  3. Clinical Services Group, Pharm D, Health Corporation of America, One Park Plaza, Bldg.II, 4W, Nashville, TN, 37203, USA

    K. Miller

Authors
  1. J. G. Thomas
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  2. L. Corum
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  3. K. Miller
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Correspondence to J. G. Thomas .

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Editors and Affiliations

  1. Department of Biomedical Sciences, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA

    Mark Shirtliff

  2. Department of Biological Sciences, Northern Arizona University, Box 5640, Flagstaff, AZ, 86011, USA

    Jeff G. Leid

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© 2008 Springer-Verlag Berlin Heidelberg

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Thomas, J.G., Corum, L., Miller, K. (2008). Biofilms and Ventilation. In: Shirtliff, M., Leid, J.G. (eds) The Role of Biofilms in Device-Related Infections. Springer Series on Biofilms, vol 3. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-68119-9_4

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