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Bacterial Colonization of Endotracheal Tubes in Intubated Neonates
David R. Friedland, MD, PhD;
Michael A. Rothschild, MD;
Mercedes Delgado, MD;
Henry Isenberg, PhD;
Ian Holzman, MD
Arch Otolaryngol Head Neck Surg. 2001;127:525-528.
Objective To obtain in vivo bacterial colonization profiles on endotracheal tubes
at different sites in the neonatal airway in an attempt to better characterize
one potential element of chondritis.
Design A case series in which cultures were obtained from calculated segments
of 33 endotracheal tubes immediately following extubation. This allowed for
sampling at specific levels of the airway corresponding to the trachea, the
subglottis, and the oropharynx. Data collected included gender, race, duration
of intubation, use of antibiotic therapy, comorbidities, gestational age at
birth and extubation, crown-rump length, weight, radiographic distance from
tube tip to carina, and culture results.
Setting Newborn intensive care unit at a tertiary care medical center.
Patients Twenty-nine neonates intubated for longer than 24 hours (range, 24 hours
to 15 days).
Main Outcome Measures Bacterial and fungal cultures obtained from 3 endotracheal tube segments
for each extubation.
Results A statistically significant difference (P<.05)
was found in colonization rates between patients intubated for less than 4
days and those intubated for longer periods. No significant difference was
noted in bacterial profile between the 3 sites.
Conclusions Data demonstrate that bacterial colonization of an indwelling object
in the neonatal airway increases with the duration of intubation. Furthermore,
4 days seems to represent a critical period in the formation of such colonization
(possibly in the form of a biofilm). These bacteria may contribute to the
chondritis known to precede the development of subglottic stenosis. Further
studies are indicated to suggest ways to interrupt this process and reduce
the incidence of airway injury.
From the Department of Otolaryngology, Johns Hopkins University, Baltimore,
Md (Dr Friedland); and the Departments of Otolaryngology (Dr Rothschild),
Pediatrics (Drs Rothschild, Delgado, and Holzman), and Microbiology (Dr Isenberg),
Mount Sinai School of Medicine, New York, NY. Dr Isenberg is now with the
Department of Pathology, Long Island Jewish Hospital, New Hyde Park, NY.
Reprints: Michael A. Rothschild, MD, Department of Otolaryngology,
Box 1189, Mount Sinai School of Medicine, Fifth Avenue and 100th Street, New
York, NY 10029-6574 (e-mail: doctormike{at}kids-ent.com).
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ABSTRACT
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