Abstract
Objective: To identify bacterial species colonizing the endotracheal tube (ETT) and to evaluate the extent of biofilm formation in patients undergoing oral hygiene protocols with 0.2% chlorhexidine. In addition, the study aimed to determine the correlation between the duration of ETT placement and the degree of bacterial biofilm formation.
Design: Observational analytic study.
Setting: Intensive Care Unit (ICU) of Dr. Soetomo General Hospital, Surabaya, Indonesia.
Patients and participants: Endotracheal tubes were collected from 41 mechanically ventilated ICU patients who had undergone routine oral hygiene with 0.2% chlorhexidine. Patients were selected consecutively, and all ETTs were processed for microbiological analysis with the roll-plate culture method and the enzyme-linked immunosorbent assay (ELISA) biofilm microplate reader.
Interventions: There was no additional therapeutic intervention beyond standard ICU care, including ventilator-associated pneumonia (VAP) bundles and chlorhexidine-based oral hygiene every 8 hours.
Measurements and results: A total of 67 bacterial isolates were obtained from the oral-exposed surface of ETTs. Among these, 85% (59 isolates) demonstrated biofilm-forming capability, with Klebsiella pneumoniae (33%), Pseudomonas aeruginosa (21%), and Acinetobacter baumannii (10%) being the most common species. Gram-negative bacteria formed the majority of biofilm-positive isolates and exhibited stronger biofilm intensity compared to Gram-positive bacteria. No statistically significant correlation was observed between ETT usage duration and biofilm intensity (p>0.05).
Conclusions: High rates of biofilm formation were identified on the outer surfaces of ETTs in ICU patients despite routine chlorhexidine oral care. No significant association was observed between the duration of ETT use and biofilm intensity. These findings highlight the need for additional preventive strategies beyond chlorhexidine to reduce the risk of biofilm-associated complications in mechanically ventilated patients.
Putri Rizkiya, Bambang Pujo Semedi, Edward Kusuma, Agung Dwi Wahyu Widodo
