A study of biofilm on endotracheal tubes in pediatric intensive care unit

Aim: This study was performed to evaluate the existence of biofilm in the endotracheal tube (ETT) of mechanically ventilated children, and to study a microbial link between biofilm flora and bacteria causing ventilator-associated pneumonia (VAP). Patients and methods: This was a prospective study conducted on 20 children with ETT who were evaluated for biofilm existence using scanning electron microscopy. Results: A total of 20 children were enrolled in the study. Of them, 17 (85%) children showed biofilm formation on the luminal surface of ETT. A significant relationship was observed between duration of intubation and biofilm stage. Of the 17 positive cases with biofilm formation, colonization of the inner ETT surface occurred in 14 (70%) cases and 17 isolates were recovered. Five isolates were Gram positive, whereas the majority of isolates were Gram-negative bacilli. Seventeen patients developed pneumonia. All patients who developed biofilm also developed VAP. The occurrence of multidrug resistance among detected microorganisms was high. Conclusion: We concluded that the density of ETT biofilm increased with increased duration of intubation. We also concluded that ETT colonization with biofilm-producing organisms increased the risk of developing VAP with highly resistant microbes.