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Erschienen in: Intensive Care Medicine 6/2008

01.06.2008 | Original

Internally coated endotracheal tubes with silver sulfadiazine in polyurethane to prevent bacterial colonization: a clinical trial

verfasst von: Lorenzo Berra, Theodor Kolobow, Patrice Laquerriere, Betsey Pitts, Simone Bramati, Joshua Pohlmann, Chiara Marelli, Miriam Panzeri, Pietro Brambillasca, Federico Villa, Andrea Baccarelli, Sylvie Bouthors, Henry T. Stelfox, Luca M. Bigatello, Joel Moss, Antonio Pesenti

Erschienen in: Intensive Care Medicine | Ausgabe 6/2008

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Abstract

Objective

Coated medical devices have been shown to reduce catheter-related infections. We coated endotracheal tubes (ETT) with silver sulfadiazine (SSD), and tested them in a clinical study to assess the feasibility, safety, and efficacy of preventing bacterial colonization.

Design

A prospective, randomized clinical trial, phase I–II.

Setting

Academic intensive care unit (ICU).

Participants

Forty-six adult patients expected to need 12–24 h of intubation were randomized into two groups.

Interventions

Patients were randomized to be intubated with a standard non-coated ETT (St-ETT, n = 23; control group), or with a SSD-coated ETT (SSD-ETT, n = 23).

Measurements and results

Coating with SSD prevented bacterial colonization of the ETT (frequency of colonization: SSD-ETT 0/23, St-ETT 8/23; p < 0.01). No organized bacterial biofilm could be identified on the lumen of any ETT; however, SSD was associated with a thinner mucus layer (in the SSD-ETT secretion deposits ranged from 0 to 200 μm; in the St-ETT deposits ranged between 50 and 700 μm). No difference was observed between the two groups in the tracheobronchial brush samples (frequency of colonization: SSD-ETT 0/23, St-ETT 2/23; p = 0.48). No adverse reactions were observed with the implementation of the novel device.

Conclusion

SSD-ETT can be safely used in preventing bacterial colonization and narrowing of the ETT in patients intubated for up to 24 h (mean intubation time 16 h).
Literatur
1.
Zurück zum Zitat Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, Wolff M, Spencer RC, Hemmer M (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 274:639–644PubMedCrossRef Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, Wolff M, Spencer RC, Hemmer M (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 274:639–644PubMedCrossRef
2.
Zurück zum Zitat National Nosocomial Infections Surveillance System (2004) National Nosocomial Infections Surveillance (NNIS) System Report: data summary from January 1992 through June 2004. Am J Infect Control 32:470–485CrossRef National Nosocomial Infections Surveillance System (2004) National Nosocomial Infections Surveillance (NNIS) System Report: data summary from January 1992 through June 2004. Am J Infect Control 32:470–485CrossRef
3.
Zurück zum Zitat Chastre J, Fagon JY (2000) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903 Chastre J, Fagon JY (2000) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903
4.
Zurück zum Zitat Hubmayr RD, Burchardi H, Elliot M, Fessler H, Georgopoulos D, Jubran A, Limper A, Pesenti A, Rubenfeld G, Stewart T, Villar J (2002) Statement of the 4th International Consensus Conference in Critical Care on ICU-Acquired Pneumonia – Chicago, Illinois, May 2002. Intensive Care Med 28:1521–1536PubMedCrossRef Hubmayr RD, Burchardi H, Elliot M, Fessler H, Georgopoulos D, Jubran A, Limper A, Pesenti A, Rubenfeld G, Stewart T, Villar J (2002) Statement of the 4th International Consensus Conference in Critical Care on ICU-Acquired Pneumonia – Chicago, Illinois, May 2002. Intensive Care Med 28:1521–1536PubMedCrossRef
5.
Zurück zum Zitat Girou E, Schortgen F, Delclaux C, Brun-Buisson C, Blot F, Lefort Y, Lemaire F, Brochard L (2000) Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA 284:2361–2367PubMedCrossRef Girou E, Schortgen F, Delclaux C, Brun-Buisson C, Blot F, Lefort Y, Lemaire F, Brochard L (2000) Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA 284:2361–2367PubMedCrossRef
6.
Zurück zum Zitat Sottile FD, Marrie TJ, Prough DS, Hobgood CD, Gower DJ, Webb LX, Costerton JW, Gristina AG (1986) Nosocomial pulmonary infection: possible etiologic significance of bacterial adhesion to endotracheal tubes. Crit Care Med 14:265–270PubMedCrossRef Sottile FD, Marrie TJ, Prough DS, Hobgood CD, Gower DJ, Webb LX, Costerton JW, Gristina AG (1986) Nosocomial pulmonary infection: possible etiologic significance of bacterial adhesion to endotracheal tubes. Crit Care Med 14:265–270PubMedCrossRef
7.
Zurück zum Zitat Inglis TJ, Millar MR, Jones JG, Robinson DA (1989) Tracheal tube biofilm as a source of bacterial colonization of the lung. J Clin Microbiol 27:2014–2018PubMed Inglis TJ, Millar MR, Jones JG, Robinson DA (1989) Tracheal tube biofilm as a source of bacterial colonization of the lung. J Clin Microbiol 27:2014–2018PubMed
8.
Zurück zum Zitat Adair CG, Gorman SP, Feron BM, Byers LM, Jones DS, Goldsmith CE, Moore JE, Kerr JR, Curran MD, Hogg G, Webb CH, McCarthy GJ, Milligan KR (1999) Implications of endotracheal tube biofilm for ventilator-associated pneumonia. Intensive Care Med 25:1072–1076PubMedCrossRef Adair CG, Gorman SP, Feron BM, Byers LM, Jones DS, Goldsmith CE, Moore JE, Kerr JR, Curran MD, Hogg G, Webb CH, McCarthy GJ, Milligan KR (1999) Implications of endotracheal tube biofilm for ventilator-associated pneumonia. Intensive Care Med 25:1072–1076PubMedCrossRef
9.
Zurück zum Zitat Costerton W, Veeh R, Shirtliff M, Pasmore M, Post C, Ehrlich G (2003) The application of biofilm science to the study and control of chronic bacterial infections. J Clin Invest 112:1466–1477PubMed Costerton W, Veeh R, Shirtliff M, Pasmore M, Post C, Ehrlich G (2003) The application of biofilm science to the study and control of chronic bacterial infections. J Clin Invest 112:1466–1477PubMed
10.
Zurück zum Zitat Berra L, De Marchi L, Yu ZX, Laquerriere P, Baccarelli A, Kolobow T (2004) Endotracheal tubes coated with antiseptics decrease bacterial colonization of the ventilator circuits, lungs, and endotracheal tube. Anesthesiology 100:1446–1456PubMedCrossRef Berra L, De Marchi L, Yu ZX, Laquerriere P, Baccarelli A, Kolobow T (2004) Endotracheal tubes coated with antiseptics decrease bacterial colonization of the ventilator circuits, lungs, and endotracheal tube. Anesthesiology 100:1446–1456PubMedCrossRef
11.
12.
Zurück zum Zitat Berra L, Panigada M, De Marchi L, Greco G, Yu ZX, Baccarelli A, Pohlmann J, Costello KF, Appleton J, Mahar R, Lewandowski R, Ravitz L, Kolobow T (2003) New approaches for the prevention of airway infection in ventilated patients. Lessons learned from laboratory animal studies at the National Institutes of Health. Minerva Anestesiol 69:342–347PubMed Berra L, Panigada M, De Marchi L, Greco G, Yu ZX, Baccarelli A, Pohlmann J, Costello KF, Appleton J, Mahar R, Lewandowski R, Ravitz L, Kolobow T (2003) New approaches for the prevention of airway infection in ventilated patients. Lessons learned from laboratory animal studies at the National Institutes of Health. Minerva Anestesiol 69:342–347PubMed
13.
Zurück zum Zitat Berra L, Curto F, Li Bassi G, Laquerriere P, Pitts B, Baccarelli A, Kolobow T (2008) Antimicrobial-coated endotracheal tubes: an experimental study. Intensive Care Med DOI 10.1007/s00134-008-1099-3 Berra L, Curto F, Li Bassi G, Laquerriere P, Pitts B, Baccarelli A, Kolobow T (2008) Antimicrobial-coated endotracheal tubes: an experimental study. Intensive Care Med DOI 10.​1007/​s00134-008-1099-3
14.
Zurück zum Zitat Jarrett F, Ellerbe S, Demling R (1978) Acute leukopenia during topical burn therapy with silver sulfadiazine. Am J Surg 135:818–819PubMedCrossRef Jarrett F, Ellerbe S, Demling R (1978) Acute leukopenia during topical burn therapy with silver sulfadiazine. Am J Surg 135:818–819PubMedCrossRef
15.
Zurück zum Zitat Fraser GL, Beaulieu JT (1979) Leukopenia secondary to sulfadiazine silver. JAMA 241:1928–1929PubMedCrossRef Fraser GL, Beaulieu JT (1979) Leukopenia secondary to sulfadiazine silver. JAMA 241:1928–1929PubMedCrossRef
16.
Zurück zum Zitat Wilson P, George R, Raine P (1986) Topical silver sulphadiazine and profound neutropenia in a burned child. Burns Incl Therm Inj 12:295–296PubMed Wilson P, George R, Raine P (1986) Topical silver sulphadiazine and profound neutropenia in a burned child. Burns Incl Therm Inj 12:295–296PubMed
17.
Zurück zum Zitat Fraser GL, Beaulieu JT (1979) Leukopenia secondary to sulfadiazine silver. JAMA 241:1928–1929PubMedCrossRef Fraser GL, Beaulieu JT (1979) Leukopenia secondary to sulfadiazine silver. JAMA 241:1928–1929PubMedCrossRef
18.
Zurück zum Zitat Hoffmann S (1984) Silver sulfadiazine: an antibacterial agent for topical use in burns. A review of the literature. Scand J Plast Reconstr Surg 18:119–126PubMedCrossRef Hoffmann S (1984) Silver sulfadiazine: an antibacterial agent for topical use in burns. A review of the literature. Scand J Plast Reconstr Surg 18:119–126PubMedCrossRef
19.
Zurück zum Zitat Gbaanador GB, Policastro AJ, Durfee D, Bleicher JN (1987) Transient leukopenia associated with topical silver sulfadiazine in burn therapy. Nebr Med J 72:83–85PubMed Gbaanador GB, Policastro AJ, Durfee D, Bleicher JN (1987) Transient leukopenia associated with topical silver sulfadiazine in burn therapy. Nebr Med J 72:83–85PubMed
20.
Zurück zum Zitat Choban PS, Marshall WJ (1987) Leukopenia secondary to silver sulfadiazine: frequency, characteristics and clinical consequences. Am Surg 53:515–517PubMed Choban PS, Marshall WJ (1987) Leukopenia secondary to silver sulfadiazine: frequency, characteristics and clinical consequences. Am Surg 53:515–517PubMed
21.
Zurück zum Zitat Fuller FW, Engler PE (1988) Leukopenia in non-septic burn patients receiving topical 1% silver sulfadiazine cream therapy: a survey. J Burn Care Rehabil 9:606–609PubMedCrossRef Fuller FW, Engler PE (1988) Leukopenia in non-septic burn patients receiving topical 1% silver sulfadiazine cream therapy: a survey. J Burn Care Rehabil 9:606–609PubMedCrossRef
22.
Zurück zum Zitat Thomson PD, Moore NP, Rice TL, Prasad JK (1989) leukopenia in acute thermal injury: evidence against topical silver sulfadiazine as the causative agent. Burn Care Rehabil 10:418–420CrossRef Thomson PD, Moore NP, Rice TL, Prasad JK (1989) leukopenia in acute thermal injury: evidence against topical silver sulfadiazine as the causative agent. Burn Care Rehabil 10:418–420CrossRef
23.
Zurück zum Zitat Viala J, Simon L, Le Pommelet C, Philippon L, Devictor D, Huault G (1997) Agranulocytosis after application of silver sulfadiazine in a 2-month old infant. Arch Pediatr 4:1103–1106PubMedCrossRef Viala J, Simon L, Le Pommelet C, Philippon L, Devictor D, Huault G (1997) Agranulocytosis after application of silver sulfadiazine in a 2-month old infant. Arch Pediatr 4:1103–1106PubMedCrossRef
24.
Zurück zum Zitat Kiker RG, Carvajal HF, Mlcak RP, Larson DL (1977) A controlled study of the effects of silver sulfadiazine on white blood cell counts in burned children. J Trauma 17:835–836PubMed Kiker RG, Carvajal HF, Mlcak RP, Larson DL (1977) A controlled study of the effects of silver sulfadiazine on white blood cell counts in burned children. J Trauma 17:835–836PubMed
25.
Zurück zum Zitat Blangy H, Simon D, Levy-Cloez A, Feillet F, Fyad JP, Trechot P, Gillet P,Lascombes P (2002) Topic silver sulfadiazine bicytopenia: first case. Therapie 57:307–309PubMed Blangy H, Simon D, Levy-Cloez A, Feillet F, Fyad JP, Trechot P, Gillet P,Lascombes P (2002) Topic silver sulfadiazine bicytopenia: first case. Therapie 57:307–309PubMed
26.
Zurück zum Zitat Eldad A, Neuman A, Weinberg A, Benmeir P, Rotem M, Wexler MR (1991) Silver sulphadiazine-induced haemolytic anaemia in a glucose-6-phosphate dehydrogenase-deficient burn patient. Burns 17:430–432PubMedCrossRef Eldad A, Neuman A, Weinberg A, Benmeir P, Rotem M, Wexler MR (1991) Silver sulphadiazine-induced haemolytic anaemia in a glucose-6-phosphate dehydrogenase-deficient burn patient. Burns 17:430–432PubMedCrossRef
27.
Zurück zum Zitat Jia XM (1985) Hypersensitivity due to topical use of silver sulfadiazine on burn wounds (report of 6 cases) Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 1:232–233PubMed Jia XM (1985) Hypersensitivity due to topical use of silver sulfadiazine on burn wounds (report of 6 cases) Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 1:232–233PubMed
28.
Zurück zum Zitat McKenna SR, Latenser BA, Jones LM, Barrette RR, Sherman HF, Varcelotti JR (1995) Serious silver sulphadiazine and mafenide acetate dermatitis. Burns 21:310–312PubMedCrossRef McKenna SR, Latenser BA, Jones LM, Barrette RR, Sherman HF, Varcelotti JR (1995) Serious silver sulphadiazine and mafenide acetate dermatitis. Burns 21:310–312PubMedCrossRef
29.
Zurück zum Zitat Fraser-Moodie A (1992) Sensitivity to silver in a patient treated with silver sulphadiazine (Flamazine). Burns 18:74–75PubMedCrossRef Fraser-Moodie A (1992) Sensitivity to silver in a patient treated with silver sulphadiazine (Flamazine). Burns 18:74–75PubMedCrossRef
30.
Zurück zum Zitat Lockhart SP, Rushworth A, Azmy AA, Raine PA (1983) Topical silver sulphadiazine: side effects and urinary excretion. Burns Incl Therm Inj 10:9–12PubMed Lockhart SP, Rushworth A, Azmy AA, Raine PA (1983) Topical silver sulphadiazine: side effects and urinary excretion. Burns Incl Therm Inj 10:9–12PubMed
31.
Zurück zum Zitat Fisher NM, Marsh E, Lazova R (2003) Scar-localized argyria secondary to silver sulfadiazine cream. J Am Acad Dermatol 49:730–732PubMedCrossRef Fisher NM, Marsh E, Lazova R (2003) Scar-localized argyria secondary to silver sulfadiazine cream. J Am Acad Dermatol 49:730–732PubMedCrossRef
32.
Zurück zum Zitat Eldad A, Icekson M, Zur T, Slosser D, Maly A, Arielli D, Burvin R, Ad-El D,Neuman A (2003) Silver-sulfadiazine eschar pigmentation mimics invasive wound infection: a case. J Burn Care Rehabil 24:154–157PubMedCrossRef Eldad A, Icekson M, Zur T, Slosser D, Maly A, Arielli D, Burvin R, Ad-El D,Neuman A (2003) Silver-sulfadiazine eschar pigmentation mimics invasive wound infection: a case. J Burn Care Rehabil 24:154–157PubMedCrossRef
33.
Zurück zum Zitat Dupuis LL, Shear NH, Zucker RM (1985) Hyperpigmentation due to topical application of silver sulfadiazine cream. J Am Acad Dermatol. 12:1112–1114PubMedCrossRef Dupuis LL, Shear NH, Zucker RM (1985) Hyperpigmentation due to topical application of silver sulfadiazine cream. J Am Acad Dermatol. 12:1112–1114PubMedCrossRef
34.
Zurück zum Zitat Payne CM, Bladin C, Colchester AC, Bland J, Lapworth R, Lane D (1992) Argyria from excessive use of topical silver sulphadiazine. Lancet 340:126PubMedCrossRef Payne CM, Bladin C, Colchester AC, Bland J, Lapworth R, Lane D (1992) Argyria from excessive use of topical silver sulphadiazine. Lancet 340:126PubMedCrossRef
35.
Zurück zum Zitat Jennings LJ, Hanumadass M (1988) Silver sulfadiazine induced Clostridium difficile toxic megacolon in a burn patient: case report. Burns 24:676–679CrossRef Jennings LJ, Hanumadass M (1988) Silver sulfadiazine induced Clostridium difficile toxic megacolon in a burn patient: case report. Burns 24:676–679CrossRef
36.
Zurück zum Zitat O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA (2002) Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep 51:1–29PubMed O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA (2002) Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep 51:1–29PubMed
37.
Zurück zum Zitat Johnson JR, Kuskowski MA, Wilt TJ (2006) Systematic review: antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients. Ann Intern Med 144:116–126PubMed Johnson JR, Kuskowski MA, Wilt TJ (2006) Systematic review: antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients. Ann Intern Med 144:116–126PubMed
38.
Zurück zum Zitat Rello J, Kollef M, Diaz E, Sandiumenge A, del Castillo Y, Corbella X, Zachskorn R (2006) Reduced burden of bacterial airway colonization with a novel silver-coated endotracheal tube in a randomized multiple-center feasibility study. Crit Care Med 34:2766–2772PubMedCrossRef Rello J, Kollef M, Diaz E, Sandiumenge A, del Castillo Y, Corbella X, Zachskorn R (2006) Reduced burden of bacterial airway colonization with a novel silver-coated endotracheal tube in a randomized multiple-center feasibility study. Crit Care Med 34:2766–2772PubMedCrossRef
39.
Zurück zum Zitat Villafane MC, Cinnella G, Lofaso F, Isabey D, Harf A, Lemaire F, Brochard L (1996) Gradual reduction of endotracheal tube diameter during mechanical ventilation via different humidification devices. Anesthesiology 85:1341–1349PubMedCrossRef Villafane MC, Cinnella G, Lofaso F, Isabey D, Harf A, Lemaire F, Brochard L (1996) Gradual reduction of endotracheal tube diameter during mechanical ventilation via different humidification devices. Anesthesiology 85:1341–1349PubMedCrossRef
40.
Zurück zum Zitat Kolobow T, Li Bassi G, Curto F, Zanella A (2006) The Mucus Slurper: A novel tracheal tube that requires no tracheal tube suctioning. A preliminary report. Intensive Care Med 32:1414–1418PubMedCrossRef Kolobow T, Li Bassi G, Curto F, Zanella A (2006) The Mucus Slurper: A novel tracheal tube that requires no tracheal tube suctioning. A preliminary report. Intensive Care Med 32:1414–1418PubMedCrossRef
41.
Zurück zum Zitat Berra L, Curto F, Li Bassi G, Laquerriere P, Baccarelli A, Kolobow T (2006) Antibacterial-coated tracheal tubes cleaned with the Mucus Shaver: a novel method to retain long-term bactericidal activity of coated tracheal tubes. Intensive Care Med 32:888–893PubMedCrossRef Berra L, Curto F, Li Bassi G, Laquerriere P, Baccarelli A, Kolobow T (2006) Antibacterial-coated tracheal tubes cleaned with the Mucus Shaver: a novel method to retain long-term bactericidal activity of coated tracheal tubes. Intensive Care Med 32:888–893PubMedCrossRef
Metadaten
Titel
Internally coated endotracheal tubes with silver sulfadiazine in polyurethane to prevent bacterial colonization: a clinical trial
verfasst von
Lorenzo Berra
Theodor Kolobow
Patrice Laquerriere
Betsey Pitts
Simone Bramati
Joshua Pohlmann
Chiara Marelli
Miriam Panzeri
Pietro Brambillasca
Federico Villa
Andrea Baccarelli
Sylvie Bouthors
Henry T. Stelfox
Luca M. Bigatello
Joel Moss
Antonio Pesenti
Publikationsdatum
01.06.2008
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 6/2008
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-008-1100-1

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