Implications and emerging control strategies for ventilator-associated infections

Abstract

Ventilator-associated pneumonia (VAP) remains a major burden to the healthcare system and intubated patients in intensive care units. In fact, VAP is responsible for at least 50% of prescribed antibiotics to patients who need mechanical ventilation. One of the factors contributing to VAP pathogenesis is believed to be rapid colonization of biofilm-forming pathogens such as Pseudomonas aeruginosa and Staphylococcus aureus on the surface of inserted endotracheal tubes. These biofilms serve as a protective environment for bacterial colonies and provide enhanced resistance towards many antibiotics. This review presents and discusses an overview of current strategies to inhibit the colonization and formation of biofilm on endotracheal tubes, including antibiotic treatment, surface modification and antimicrobial agent incorporation onto endotracheal tube materials.

Keywords:

• biofilm
• Pseudomonas aeruginosa
• silver nanoparticle
• Staphylococcus aureus
• surface modification
• ventilator-associated pneumonia

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Endotracheal tubes in intensive care units are essential for ventilation but are a major source of infection and ventilator-associated pneumonia (VAP).

• VAP affects up to 28% of intubated patients and the incidence rate escalates with time post-ventilation.

• After bacterial adhesion to intubation tubes, biofilm formation can occur making it difficult to remove potential sources of VAP via conventional antibiotics.

• Guidelines for reducing VAP are not uniform and there is no cohesive clinical strategy for reducing VAP-associated mortality.

• Reducing bacterial adhesion is a key strategy for reducing biofilm formation and VAP through surface modification of intubation tubes.

• Actively ‘targeting bacteria’ by incorporating antibacterial drugs or metal ions/nanoparticles into tubes is another strategy.

• Clinical trials have shown some success using silver-coated endotracheal tubes.

• Developing improved endotracheal tubes that prevent VAP and reduce VAP-related mortality has the potential to improve healthcare outcomes and reduce intensive care unit costs.