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Preventive Strategies in VAP: Focus on Silver-Coated Endotracheal Tubes

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Biomaterials Associated Infection

Abstract

Introduction: Ventilator-associated pneumonia (VAP) is problematic because of its frequency, morbidity, and mortality. Many strategies have been studied in an attempt to reduce the rate of VAP. This chapter provides a comprehensive review of silver-coated endotracheal tubes in the prevention of VAP.

Methods: Two silver-coated endotracheal tubes have been studied in comparison with similar, uncoated tubes—each beginning with preclinical models and progressing to clinical studies. One is commercially available (Agento® IC, C. R. Bard, Covington, Georgia, United States) and is coated with silver ions micro-dispersed in a proprietary hydrophilic polymer. The other remains investigational and is prepared by submerging a standard endotracheal tube into silver sulfadiazine (with or without chlorhexidine) and polyurethane.

Results: Both silver-coated tubes were active in preclinical models designed to mimic surrogate endpoints for VAP, such as in vitro bacterial adherence, biofilm formation, and bacterial burden in animal models. Both tubes were active in phase 2 studies of patients requiring mechanical ventilation. The commercially available tube was active in a randomized, phase 3 study and reduced the incidence of microbiologically confirmed VAP at any time after intubation (silver vs. uncoated, 37/766 [4.8 %] vs. 56/743 [7.5 %]; P = 0.03; relative risk reduction, 35.9 %) and within 10 days of intubation (27/766 [3.5 %] vs. 50/743 [6.7 %]; P = 0.005, relative risk reduction, 47.6 %).

Conclusions: The silver-coated endotracheal tube is a promising strategy for preventing VAP. The commercially available tube meets the standards for evidence-based guidelines because effectiveness is supported by the results of a well-designed, phase 3 study. In addition, the device is suitable for use in the intensive care unit because it becomes user independent after intubation and does not add to the burden of busy healthcare providers.

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Abbreviations

AMMI Canada:

Association of Medical Microbiology and Infectious Disease Canada

ATS/IDSA:

American Thoracic Society/Infectious Diseases Society of America

BSAC:

British Society for Antimicrobial Chemotherapy

CCCTG:

Canadian Critical Care Trials Group

CPIS:

Clinical pulmonary infection score

GPP:

Good practice point

HAP:

Healthcare-associated pneumonia

ICU:

Intensive care unit

IHI:

Institute for Healthcare Improvement

NASCENT study:

North American Silver-Coated Endotracheal Tube study

NHSN:

National Healthcare Safety Network

SHEA/IDSA:

Society for Healthcare Epidemiology of America/IDSA

SMART:

Specific, measurable, achievable, relevant, and time bound

VAP:

Ventilator-associated pneumonia

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Authors and Affiliations

  1. Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 63110, USA

    Marin Kollef

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  1. Marin Kollef
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Correspondence to Marin Kollef .

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Editors and Affiliations

  1. AO Research Institute Davos, Clavadelerstrasse 8, Davos Platz, 7270, Switzerland

    T. Fintan Moriarty

  2. , Medical Microbiology, Academic Medical Center, Meibergdreef 15, Amsterdam, 1105 AZ, Netherlands

    Sebastian A.J. Zaat

  3. University Medical Center Groningen, A. Deusinglaan 1, Groningen, 9713 AV, Netherlands

    Henk J. Busscher

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Kollef, M. (2013). Preventive Strategies in VAP: Focus on Silver-Coated Endotracheal Tubes. In: Moriarty, T., Zaat, S., Busscher, H. (eds) Biomaterials Associated Infection. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1031-7_21

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