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Correspondence |

Does Biofilm Formation Play a Role in Ventilator-Associated Tracheobronchitis? FREE TO VIEW

Paul Drinka, MD
Author and Funding Information

Affiliations: Dr. Drinka is affiliated with the University of Wisconsin.

Correspondence to: Paul Drinka, MD, University of Wisconsin, Department of Internal Medicine, N3379 Bailey St, Waupaca, WI 54981; e-mail: pauldrinka@sbcglobal.net


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(4):1190-1191. doi:10.1378/chest.09-0465
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I enjoyed reading “Ventilator-Associated Tracheobronchitis” by Craven et al1 in a recent issue of CHEST (February 2009). It may be useful to determine whether this condition includes biofilm formation. The authors mentioned contiguous biofilm sites including the endotracheal tube and oral cavity. Dental plaque is a form of biofilm that supports the growth of pulmonary pathogens and is a probable source of pneumonia. Oral hygiene decreases rates of ventilator-associated pneumonia in some groups.2

Pseudomonas and Staphylococcus aureus are biofilm formers.35 Biofilm colonies anchor to mucosal surfaces or foreign bodies and are composed of layers of slow-growing bacteria embedded in the glycocalyx (exopolysaccarides). The close proximity of bacteria facilitates chemical quorum sensing when the colony achieves high density, triggering the production of virulence factors and/or launching free-living bacteria to infect other sites such as the alveolae. Glycocalyx interferes with antibiotic penetration, and slow growth makes bacteria resistant to growth-dependent antibiotic killing. Killing bacteria in biofilm requires antibiotic concentrations 10 to 1,000 times that needed to kill free-living bacteria. Conceivably, topical or aerosolized antibiotics could achieve local concentrations high enough to suppress biofilm formation and avoid exposing bacteria to sub-minimum inhibitory antibiotic concentrations if the biofilm was not fully mature. Other novel therapies that can be directed toward the formation of biofilms or are capable of breaking the chemical bonds of the biofilms may become available.35

The exopolysaccarides in biofilm cannot be visualized by conventional light microscopy.4 Detection requires scanning electron or laser microscopy. Fluorescent in situ hybridization is required to identify specific bacteria.3 These techniques have demonstrated the presence of biofilm and clarified the pathophysiology of ear, nose, and throat infections, including chronic sinusitis, otitis media with effusion, and adenotonsillitis.5 Perhaps it is time to apply the same techniques to determine whether biofilm formation is part of the pathophysiology of ventilator-associated tracheobronchitis.

Financial/nonfinancial disclosures: The author has reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Craven DE, Chroneou A, Zias N, et al. Ventilator-associated tracheobronchitis: the impact of targeted antibiotic therapy on patient outcomes. Chest. 2009;135:521-528. [PubMed] [CrossRef]
 
Paju S, Scannapieco FA. Oral biofilms, perodontitis, and pulmonary infections. Oral Dis. 2007;13:508-512. [PubMed]
 
Prince AA, Steiger JD, Khalid AN, et al. Prevalence of biofilms-forming bacteria in chronic rhinosinusitis. Am J Rhinol. 2008;22:239-245. [PubMed]
 
Kobayashi H. Airway biofilms: implications for pathogenesis and therapy of respiratory tract infections. Treat Respir Med. 2005;4:241-253. [PubMed]
 
Kilty SJ, Desrosiers MY. The role of bacterial biofilms and the pathophysiology of chronic rhinosinusitis. Curr Allergy Asthma Rep. 2008;8:227-233. [PubMed]
 

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References

Craven DE, Chroneou A, Zias N, et al. Ventilator-associated tracheobronchitis: the impact of targeted antibiotic therapy on patient outcomes. Chest. 2009;135:521-528. [PubMed] [CrossRef]
 
Paju S, Scannapieco FA. Oral biofilms, perodontitis, and pulmonary infections. Oral Dis. 2007;13:508-512. [PubMed]
 
Prince AA, Steiger JD, Khalid AN, et al. Prevalence of biofilms-forming bacteria in chronic rhinosinusitis. Am J Rhinol. 2008;22:239-245. [PubMed]
 
Kobayashi H. Airway biofilms: implications for pathogenesis and therapy of respiratory tract infections. Treat Respir Med. 2005;4:241-253. [PubMed]
 
Kilty SJ, Desrosiers MY. The role of bacterial biofilms and the pathophysiology of chronic rhinosinusitis. Curr Allergy Asthma Rep. 2008;8:227-233. [PubMed]
 
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