Bacterial colonization of endotracheal tubes in intubated neonates

Objective: To obtain in vivo bacterial colonization profiles on endotrachea l tubes at different sites in the neonatal airway in an attempt to better c haracterize one potential element of chondritis. Design: A case series in which cultures were obtained from calculated segme nts of 33 endotracheal tubes immediately following extubation. This allowed for sampling at specific levels of the airway corresponding to the trachea , the subglottis, and the oropharynx. Data collected included gender, race, duration of intubation, use of antibiotic therapy, comorbidities. gestatio nal age at birth and extubation, crown-rump length, weight, radiographic di stance from tube tip to carina, and culture results. Setting: Newborn intensive care unit at a tertiary care medical center. Patients: Twenty-nine neonates intubated for longer than 24 hours (range, 2 4 hours to 15 days). Main Outcome Measures: Bacterial and fungal cultures obtained from 33 endot racheal tube segments for each extubation. Results: A statistically significant difference (P < .05) was found in colo nization rates between patients intubated for less than 4 days and those in tubated for longer periods. No significant difference was noted in bacteria l profile between the 3 sites. Conclusions: Data demonstrate that bacterial colonization of an indwelling object in the neonatal airway increases with the duration of intubation. Fu rthermore, 4 days seems to represent a critical period in the formation of such colonization (possibly in the form of a biofilm). These bacteria ma): contribute to the chondritis known to precede the development of subglottic stenosis. Further studies are indicated to suggest ways to interrupt this process and reduce the incidence of aim-a) injury.