Bacteriology of endotracheal tube biofilms and antibiotic resistance: a systematic review

S K Mishra; S Baidya; A Bhattarai; S Shrestha; S Homagain; B Rayamajhee; A Hui; M Willcox

doi:10.1016/j.jhin.2024.03.004

Bacteriology of endotracheal tube biofilms and antibiotic resistance: a systematic review

J Hosp Infect. 2024 May:147:146-157. doi: 10.1016/j.jhin.2024.03.004. Epub 2024 Mar 22.

Authors

S K Mishra¹, S Baidya², A Bhattarai², S Shrestha², S Homagain², B Rayamajhee³, A Hui⁴, M Willcox³

Affiliations

¹ School of Optometry and Vision Science, Faculty of Health and Medicine, University of New South Wales, Sydney, Australia; Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal. Electronic address: s.mishrabaishnab@unsw.edu.au.
² Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
³ School of Optometry and Vision Science, Faculty of Health and Medicine, University of New South Wales, Sydney, Australia.
⁴ School of Optometry and Vision Science, Faculty of Health and Medicine, University of New South Wales, Sydney, Australia; Center for Ocular Research and Education, School of Optometry &Vision Science, University of Waterloo, Ontario, Canada.

PMID: 38522561
DOI: 10.1016/j.jhin.2024.03.004

Abstract

Bacteria commonly adhere to surfaces and produce polymeric material to encase the attached cells to form communities called biofilms. Within these biofilms, bacteria can appear to be many times more resistant to antibiotics or disinfectants. This systematic review explores the prevalence and microbial profile associated with biofilm production of bacteria isolated from endotracheal tubes and its associations with antimicrobial resistance. A comprehensive search was performed on databases PubMed, Embase, and Google Scholar for relevant articles published between 1^st January 2000 and 31^st December 2022. The relevant articles were exported to Mendeley Desktop 1.19.8 and screened by title and abstract, followed by full text screening based on the eligibility criteria of the study. Quality assessment of the studies was performed using the Newcastle-Ottawa Scale (NOS) customized for cross-sectional studies. Furthermore, the prevalence of antimicrobial resistance in biofilm-producers isolated from endotracheal tube specimens was investigated. Twenty studies encompassing 981 endotracheal tubes met the eligibility criteria. Pseudomonas spp. and Acinetobacter spp. were predominant isolates among the biofilm producers. These biofilms provided strong resistance against commonly used antibiotics. The highest resistance rate observed in Pseudomonas spp. was against fluoroquinolones whereas the least resistance was seen against piperacillin-tazobactam. A similar trend of susceptibility was observed in Acinetobacter spp. with a very high resistance rate against fluoroquinolones, third-generation cephalosporins and carbapenems. In conclusion, endotracheal tubes were associated with colonization by biofilm forming bacteria with varying levels of antimicrobial resistance. Biofilms may promote the occurrence of recalcitrant infections in endotracheal tubes which need to be managed with appropriate protocols and antimicrobial stewardship. Research focus should shift towards meticulous exploration of biofilm-associated infections to improve detection and management.

Keywords: Antimicrobial resistance; Biofilm; Endotracheal tube; Nosocomial infection.

Publication types

Systematic Review
Review

MeSH terms

Anti-Bacterial Agents / pharmacology
Bacteria / classification
Bacteria / drug effects
Bacteria / isolation & purification
Biofilms* / drug effects
Biofilms* / growth & development
Drug Resistance, Bacterial*
Humans
Intubation, Intratracheal*