Sphingosine Prevents Bacterial Adherence to Endotracheal Tubes: A Novel Mechanism to Prevent Ventilator-Associated Pneumonia
Technical Report,02 Jun 2014,30 Sep 2015
University of Cincinnati Cincinnati United States
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Ventilator-associated pneumonia VAP is one of the most common nosocomial infections causing significant morbidity and mortality in critically ill patients. VAP prevention is an area that has received much attention. Bacteria responsible for VAP are diverse however, 60 of causative agents are Gram-negative bacteria, most commonly Pseudomonas aeruginosa PA and Acine to bacter baumannii AB. The cause of VAP is multifactorial, but is undeniably related to the presence of the endotracheal tube ETT.Tracheal intubation inhibits the cough reflex, affects mucociliary clearance, provides direct access for bacteria from the upper to the lower respiratory system, and allows for the formation of biofilm, which can subsequently be a source of persistent infection. Thus, prevention of bacterial adherence on the surface of ETTs could have potential to significantly reduce rates of VAP. In this study, we used an in vitro bacterial adherence model to study the effectiveness and durability of sphingosine and phytosphingosine coating to reduce bacterial adherence of AB, PA, and Staphylococcus aureus to the surface of ETTs compared to standard plasticized polyvinylchloride and silver-coated ETTs. Our data show that sphingosine-coated and phytosphingosine-coated ETTs are highly efficacious at preventing bacterial adherence against three of the most common pathogens, AB, PA, and Staphylococcus aureus, associated with VAP when compared with standard plasticized polyvinyl chloride ETTs. Additionally, our data indicate our sphingolipid-coated tubes are equally efficacious as silver-coated ETTs. Future in vitro and animal studies are necessary to establish the safety of sphingolipid coatings, and future randomized clinical trials will be necessary to determine sphingosine or phytosphingosine s ability to provide a cost-effective preventative strategy to reduce rates of VAP.