Abstract
In critically ill patients, breathing is impaired and mechanical ventilation, using an endotracheal tube (ET) connected to a ventilator, is necessary. Although mechanical ventilation is a life-saving procedure, it is not without risk. Because of several reasons, a biofilm often forms at the distal end of the ET and this biofilm is a persistent source of bacteria which can infect the lungs, causing ventilator-associated pneumonia (VAP). There is a link between the microbial flora of ET biofilms and the microorganisms involved in the onset of VAP. Culture dependent and independent techniques were already used to identify the microbial flora of ET biofilms and also, the antibiotic resistance of microorganisms obtained from ET biofilms was determined. The ESKAPE pathogens play a dominant role in the onset of VAP and these organisms were frequently identified in ET biofilms. Also, antibiotic resistant microorganisms were frequently present in ET biofilms. Members of the normal oral flora were also identified in ET biofilms but it is thought that these organisms initiate ET biofilm formation and are not directly involved in the development of VAP.
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References
Abdel-Hady H, Hawas S, El-Daker M et al (2008) Extended-spectrum beta-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit. J Perinatol 28:685–690
Abreu AG, Marques SG, Monteiro-Neto V et al (2011) Nosocomial infection and characterization of extended-spectrum beta-lactamases-producing Enterobacte-riaceae in Northeast Brazil. Rev Soc Bras Med Trop 44:441–446
Abu Samra M, El Bendary H, Hayes SM et al (2013) Role of topical antibiotic prophylaxis in prevention of bacterial translocation into upper trachea in nasally intubated patients undergoing tonsillectomies. Int J Pediatr Otorhinolaryngol 77:270–274
Adair CG, Gorman SP, Feron BM et al (1999) Implications of endotracheal tube biofilm for ventilator-associated pneumonia. Intensive Care Med 25:1072–1076
Agarwal A, Singh KP, Jain A (2010) Medical significance and management of staphylococcal biofilm. FEMS Immunol Med Microbiol 58:147–160
Alangaden GJ (2011) Nosocomial fungal infections: epidemiology, infection control, and prevention. Infect Dis Clin North Am 25:201–225
Alcaraz LD, Belda-Ferre P, Cabrera-Rubio R et al (2012) Identifying a healthy oral microbiome through metagenomics. Clin Microbiol Infect 18(Suppl 4):54–57
Alhede M, Bjarnsholt T, Givskov M et al (2014) Pseudomonas aeruginosa biofilms: mechanisms of immune evasion. Adv Appl Microbiol 86:1–40
American Thoracic Society IDSOA (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171:388–416
Antunes AL, Trentin DS, Bonfanti JW et al (2010) Application of a feasible method for determination of biofilm antimicrobial susceptibility in staphylococci. APMIS 118:873–877
Antunes LC, Visca P, Towner KJ (2014) Acinetobacter baumannii: evolution of a global pathogen. Pathog Dis 71:292–301
Badiee P, Alborzi A, Joukar M (2011) Molecular assay to detect nosocomial fungal infections in intensive care units. Eur J Intern Med 22:611–615
Bahrani-Mougeot FK, Paster BJ, Coleman S et al (2007) Molecular analysis of oral and respiratory bacterial species associated with ventilator-associated pneumonia. J Clin Microbiol 45:1588–1593
Bakaletz LO (2004) Developing animal models for polymicrobial diseases. Nat Rev Microbiol 2:552–568
Bassetti M, Righi E, Fasce R et al (2007) Efficacy of ertapenem in the treatment of early ventilator-associated pneumonia caused by extended-spectrum beta-lactamase-producing organisms in an intensive care unit. J Antimicrob Chemother 60:433–435
Becker K, Von Eiff C (2012) Staphylococcus, Micrococcus, and other catalase-positive cocci. In: Versalovic J (ed) Manual of clinical microbiology. ASM press, Washington, DC
Berra L, Coppadoro A, Bittner EA et al (2012) A clinical assessment of the Mucus Shaver: a device to keep the endotracheal tube free from secretions. Crit Care Med 40:119–124
Bielecki P, Glik J, Kawecki M et al (2008) Towards understanding Pseudomonas aeruginosa burn wound infections by profiling gene expression. Biotechnol Lett 30:777–790
Bittar F, Rolain JM (2010) Detection and accurate identification of new or emerging bacteria in cystic fibrosis patients. Clin Microbiol Infect 16:809–820
Bjarnsholt T, Givskov M (2007) The role of quorum sensing in the pathogenicity of the cunning aggressor Pseudomonas aeruginosa. Anal Bioanal Chem 387:409–414
Bleves S, Viarre V, Salacha R et al (2010) Protein secretion systems in Pseudomonas aeruginosa: a wealth of pathogenic weapons. Int J Med Microbiol 300:534–543
Bloemendaal AL, Brouwer EC, Fluit AC (2010) Methicillin resistance transfer from Staphylocccus epidermidis to methicillin-susceptible Staphylococcus aureus in a patient during antibiotic therapy. PLoS ONE 5:e11841
Bodro M, Guidiol C, Garcia-Vidal C et al (2014) Epidemiology, antibiotic therapy and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in cancer patients. Support Care Cancer 22:603–610
Bonomo RA, Szabo D (2006) Mechanisms of multidrug resistance in Acinetobacter species and Pseudomonas aeruginosa. Clin Infect Dis 43(Suppl 2):S49–S56
Bousbia S, Raoult D, La Scola B (2013) Pneumonia pathogen detection and microbial interactions in polymicrobial episodes. Future Microbiol 8:633–660
Branski LK, Al-Mousawi A, Rivero H et al (2009) Emerging infections in burns. Surg Infect (Larchmt) 10:389–397
Bregeon F, Ciais V, Carret V et al (2001) Is ventilator-associated pneumonia an independent risk factor for death? Anesthesiology 94:554–560
Bukholm G, Tannaes T, Kjelsberg AB et al (2002) An outbreak of multidrug-resistant Pseudomonas aeruginosa associated with increased risk of patient death in an intensive care unit. Infect Control Hosp Epidemiol 23:441–446
Cairns S, Thomas JG, Hooper SJ et al (2011) Molecular analysis of microbial communities in endotracheal tube biofilms. PLoS ONE 6:e14759
Celik IH, Oguz SS, Demirel G et al (2012) Outcome of ventilator-associated pneumonia due to multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa treated with aerosolized colistin in neonates: a retrospective chart review. Eur J Pediatr 171:311–316
Cerca N, Martins S, Cerca F et al (2005) Comparative assessment of antibiotic susceptibility of coagulase-negative staphylococci in biofilm versus planktonic culture as assessed by bacterial enumeration or rapid XTT colorimetry. J Antimicrob Chemother 56:331–336
Chang EP, Chiang DH, Lin ML et al (2009) Clinical characteristics and predictors of mortality in patients with Enterobacter aerogenes bacteremia. J Microbiol Immunol Infect 42:329–335
Charles MP, Easow JM, Joseph NM et al (2013) Aetiological agents of ventilator-associated pneumonia and its resistance pattern – a threat for treatment. Aust Med J 6:430–434
Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903
Chastre J, Trouillet JL, Vuagnat A et al (1998) Nosocomial pneumonia in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 157:1165–1172
Chatterjee SS, Otto M (2013) Improved understanding of factors driving methicillin-resistant Staphylococcus aureus epidemic waves. Clin Epidemiol 5:205–217
Cheung N, Betro G, Luckianow G et al (2007) Endotracheal intubation: the role of sterility. Surg Infect (Larchmt) 8:545–552
Ciric L, Mullany P, Roberts AP (2011) Antibiotic and antiseptic resistance genes are linked on a novel mobile genetic element: Tn6087. J Antimicrob Chemother 66:2235–2239
Coenye T, Nelis HJ (2010) In vitro and in vivo model systems to study microbial biofilm formation. J Microbiol Methods 83:89–105
Collins MD, Lawson PA (2000) The genus Abiotrophia (Kawamura et al.) is not monophyletic: proposal of Granulicatella gen. nov., Granulicatella adiacens comb. nov., Granulicatella elegans comb. nov. and Granulicatella balaenopterae comb. nov. Int J Syst Evol Microbiol 50(Pt 1):365–369
Cornelis P, Dingemans J (2013) Pseudomonas aeruginosa adapts its iron uptake strategies in function of the type of infections. Front Cell Infect Microbiol 3:75
Costerton JW, Stewart PS, Greenberg EP (1999) Bacterial biofilms: a common cause of persistent infections. Science 284:1318–1322
Costerton JW, Post JC, Ehrlich GD et al (2011) New methods for the detection of orthopedic and other biofilm infections. FEMS Immunol Med Microbiol 61:133–140
Da Costa PS, Tostes MM, De Carvalho Valle LM (2000) A case of keratoconjunctivitis due to Ewingella americana and a review of unusual organisms causing external eye infections. Braz J Infect Dis 4:262–267
Damron FH, Goldberg JB (2012) Proteolytic regulation of alginate overproduction in Pseudomonas aeruginosa. Mol Microbiol 84:595–607
Daniluk T, Tokajuk G, Cylwik-Rokicka D et al (2006) Aerobic and anaerobic bacteria in subgingival and supragingival plaques of adult patients with periodontal disease. Adv Med Sci 51(Suppl 1):81–85
Deem S, Treggiari MM (2010) New endotracheal tubes designed to prevent ventilator-associated pneumonia: do they make a difference? Respir Care 55:1046–1055
Delisle MS, Williamson DR, Albert M et al (2011) Impact of Candida species on clinical outcomes in patients with suspected ventilator-associated pneumonia. Can Respir J 18:131–136
Depuydt P, Benoit D, Vogelaers D et al (2008) Systematic surveillance cultures as a tool to predict involvement of multidrug antibiotic resistant bacteria in ventilator-associated pneumonia. Intensive Care Med 34:675–682
Dewhirst FE, Chen T, Izard J et al (2010) The human oral microbiome. J Bacteriol 192:5002–5017
Dhanireddy S, Altemeier WA, Matute-Bello G et al (2006) Mechanical ventilation induces inflammation, lung injury, and extra-pulmonary organ dysfunction in experimental pneumonia. Lab Invest 86:790–799
Dickson RP, Martinez SM, Ortiz JR (2008) A case of rapidly progressive necrotizing pneumonia caused by community-acquired methicillin-resistant Staphylococcus aureus. Respir Care 53:1223–1226
Diez-Aguilar M, Ruiz-Garbajosa P, Fernandez-Olmos A et al (2013) Non-diphtheriae Corynebacterium species: an emerging respiratory pathogen. Eur J Clin Microbiol Infect Dis 32:769–772
Donlan RM, Costerton JW (2002) Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev 15:167–193
Downes J, Wade WG (2006) Peptostreptococcus stomatis sp. nov., isolated from the human oral cavity. Int J Syst Evol Microbiol 56:751–754
Doyle JS, Buising KL, Thursky KA et al (2011) Epidemiology of infections acquired in intensive care units. Semin Respir Crit Care Med 32:115–138
Ebringer A, Rashid T (2013) Rheumatoid arthritis is caused by a Proteus urinary tract infection. APMIS
Eisenblatter M, Klaus C, Pletz MW et al (2008) Influence of azithromycin and clarithromycin on macrolide susceptibility of viridans streptococci from the oral cavity of healthy volunteers. Eur J Clin Microbiol Infect Dis 27:1087–1092
El-Ebiary M, Torres A, Fabregas N et al (1997) Significance of the isolation of Candida species from respiratory samples in critically ill, non-neutropenic patients. An immediate postmortem histologic study. Am J Respir Crit Care Med 156:583–590
Endimiani A, Luzzaro F, Brigante G et al (2005) Proteus mirabilis bloodstream infections: risk factors and treatment outcome related to the expression of extended-spectrum beta-lactamases. Antimicrob Agents Chemother 49:2598–2605
Esteban J, Gomez-Barrena E, Cordero J et al (2008) Evaluation of quantitative analysis of cultures from sonicated retrieved orthopedic implants in diagnosis of orthopedic infection. J Clin Microbiol 46:488–492
Esteban J, Molina-Manso D, Spiliopoulou I et al (2010) Biofilm development by clinical isolates of Staphy-lococcus spp. from retrieved orthopedic prostheses. Acta Orthop 81:674–679
Feldman C, Kassel M, Cantrell J et al (1999) The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation. Eur Respir J 13:546–551
Flanagan JL, Brodie EL, Weng L et al (2007) Loss of bacterial diversity during antibiotic treatment of intubated patients colonized with Pseudomonas aeruginosa. J Clin Microbiol 45:1954–1962
Flemming HC (2002) Biofouling in water systems–cases, causes and countermeasures. Appl Microbiol Biotechnol 59:629–640
Gallo S, Chevalier J, Mahamoud A et al (2003) 4-alkoxy and 4-thioalkoxyquinoline derivatives as chemosensitizers for the chloramphenicol-resistant clinical Enterobacter aerogenes 27 strain. Int J Antimicrob Agents 22:270–273
Gibbs K, Holzman IR (2012) Endotracheal tube: friend or foe? Bacteria, the endotracheal tube, and the impact of colonization and infection. Semin Perinatol 36:454–461
Gil-Perotin S, Ramirez P, Marti V et al (2012) Implications of endotracheal tube biofilm in ventilator-associated pneumonia response: a state of concept. Crit Care 16:R93
Gomes F, Teixeira P, Oliviera R (2014) Mini-review: Staphylococcus epidermidis as the most frequent cause of nosocomial infections: old and new fighting strategies. Biofouling 30:131–141
Grimont F, Grimont PD (2006) The genus Enterobacter. In: Martin D, Stanley F, Eugene R, Karl-Heinz S, Erko S (eds) The prokaryotes. Springer, New York
Gronow S, Welnitz S, Lapidus A et al (2010) Complete genome sequence of Veillonella parvula type strain (Te3). Stand Genomic Sci 2:57–65
Guerrero DM, Perez F, Conger NG et al (2010) Acinetobacter baumannii-associated skin and soft tissue infections: recognizing a broadening spectrum of disease. Surg Infect (Larchmt) 11:49–57
Guiot HF, Corel LJ, Vossen JM (1994) Prevalence of penicillin-resistant viridans streptococci in healthy children and in patients with malignant haematological disorders. Eur J Clin Microbiol Infect Dis 13:645–650
Gursel G, Aydogdu M, Nadir Ozis T et al (2010) Comparison of the value of initial and serial endotracheal aspirate surveillance cultures in predicting the causative pathogen of ventilator-associated pneumonia. Scand J Infect Dis 42:341–346
Haddadin AS, Fappiano SA, Lipsett PA (2002) Methicillin resistant Staphylococcus aureus (MRSA) in the intensive care unit. Postgrad Med J 78:385–392
Hall-Stoodley L, Stoodley P (2005) Biofilm formation and dispersal and the transmission of human pathogens. Trends Microbiol 13:7–10
Hancock RE, Speert DP (2000) Antibiotic resistance in Pseudomonas aeruginosa: mechanisms and impact on treatment. Drug Resist Updat 3:247–255
Hartzell JD, Kim AS, Kortepeter MG et al (2007) Acinetobacter pneumonia: a review. Med Gen Med 9:4
Hayon J, Figliolini C, Combes A et al (2002) Role of serial routine microbiologic culture results in the initial management of ventilator-associated pneumonia. Am J Respir Crit Care Med 165:41–46
Hidron AI, Edwards JR, Patel J et al (2008) NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol 29:996–1011
Hughes CV, Kolenbrander PE, Andersen RN et al (1988) Coaggregation properties of human oral Veillonella spp.: relationship to colonization site and oral ecology. Appl Environ Microbiol 54:1957–1963
Inglis TJ, Millar MR, Jones JG et al (1989) Tracheal tube biofilm as a source of bacterial colonization of the lung. J Clin Microbiol 27:2014–2018
Inglis TJ, Lim TM, Ng ML et al (1995) Structural features of tracheal tube biofilm formed during prolonged mechanical ventilation. Chest 108:1049–1052
Jacinto RC, Montagner F, Signoretti FG et al (2008) Frequency, microbial interactions, and antimicrobial susceptibility of Fusobacterium nucleatum and Fusobacterium necrophorum isolated from primary endodontic infections. J Endod 34:1451–1456
Jenkinson HF (2011) Beyond the oral microbiome. Environ Microbiol 13:3077–3087
Jones RN (2010) Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis 51(Suppl 1):S81–S87
Jones DS, Mcgovern JG, Woolfson AD et al (1997) Role of physiological conditions in the oropharynx on the adherence of respiratory bacterial isolates to endotracheal tube poly(vinyl chloride). Biomaterials 18:503–510
Joseph NM, Sistla S, Dutta TK et al (2010) Ventilator-associated pneumonia: a review. Eur J Intern Med 21:360–368
Jung B, Sebbane M, Chanques G et al (2009) Previous endotracheal aspirate allows guiding the initial treatment of ventilator-associated pneumonia. Intensive Care Med 35:101–107
Kallen AJ, Hidron AI, Patel J et al (2010) Multidrug resistance among gram-negative pathogens that caused healthcare-associated infections reported to the National Healthcare Safety Network, 2006–2008. Infect Control Hosp Epidemiol 31:528–531
Kempf M, Rolain JM (2012) Emergence of resistance to carbapenems in Acinetobacter baumannii in Europe: clinical impact and therapeutic options. Int J Antimicrob Agents 39:105–114
Khajuria A, Praharaj AK, Grover N et al (2013) First report of blaNDM-1 in Raoultella ornithinolytica. Antimicrob Agents Chemother 57:1092–1093
Kindblom C, Davies JR, Herzberg MC et al (2012) Salivary proteins promote proteolytic activity in Streptococcus mitis biovar 2 and Streptococcus mutans. Mol Oral Microbiol 27:362–372
Kitada K, Oho T (2012) Effect of saliva viscosity on the co-aggregation between oral streptococci and Actinomyces naeslundii. Gerodontology 29:e981–e987
Klepac-Ceraj V, Lemon KP, Martin TR et al (2010) Relationship between cystic fibrosis respiratory tract bacterial communities and age, genotype, antibiotics and Pseudomonas aeruginosa. Environ Microbiol 12:1293–1303
Kloos WE, Musselwhite MS (1975) Distribution and persistence of Staphylococcus and Micrococcus species and other aerobic bacteria on human skin. Appl Microbiol 30:381–385
Kolenbrander PE, Andersen RN, Blehert DS et al (2002) Communication among oral bacteria. Microbiol Mol Biol Rev 66:486–505, table of contents
Kollef MH, Afessa B, Anzueto A et al (2008) Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA 300:805–813
Kostakioti M, Hadjifrangiskou M, Hultgren SJ (2013) Bacterial biofilms: development, dispersal, and therapeutic strategies in the dawn of the postantibiotic era. Cold Spring Harb Perspect Med 3:a010306
Kouidhi B, Zmantar T, Mahdouani K et al (2011) Antibiotic resistance and adhesion properties of oral Enterococci associated to dental caries. BMC Microbiol 11:155
Krishnamurthy V, Vijaykumar GS, Kumar MS et al (2013) Phenotypic and genotypic methods for detection of extended spectrum beta lactamase producing Escherichia coli and Klebsiella pneumoniae isolated from ventilator associated pneumonia. J Clin Diagn Res 7:1975–1978
Lasken RS (2012) Genomic sequencing of uncultured microorganisms from single cells. Nat Rev Microbiol 10:631–640
Lazarevic V, Gaia N, Girard M et al (2013) Comparison of DNA extraction methods in analysis of salivary bacterial communities. PLoS ONE 8:e67699
Liao TL, Lin AC, Chen E et al (2012) Complete genome sequence of Klebsiella oxytoca E718, a New Delhi metallo-beta-lactamase-1-producing nosocomial strain. J Bacteriol 194:5454
Lindsay D, Von Holy A (2006) Bacterial biofilms within the clinical setting: what healthcare professionals should know. J Hosp Infect 64:313–325
Liu W, Zuo Z, Ma R et al (2013) Effect of mechanical cleaning of endotracheal tubes with sterile urethral catheters to reduce biofilm formation in ventilator patients. Pediatr Crit Care Med 14:e338–e343
Livermore DM (2002) Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst nightmare? Clin Infect Dis 34:634–640
Lorente L, Lecuona M, Jimenez A et al (2007) Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. Am J Respir Crit Care Med 176:1079–1083
Luna CM, Sibila O, Agusti C et al (2009) Animal models of ventilator-associated pneumonia. Eur Respir J 33:182–188
Luna CM, Sarquis S, Niederman MS et al (2013) Is a strategy based on routine endotracheal cultures the best way to prescribe antibiotics in ventilator-associated pneumonia? Chest 144:63–71
Lung M, Codina G (2012) Molecular diagnosis in HAP/VAP. Curr Opin Crit Care 18:487–494
Master RN, Deane J, Opiela C et al (2013) Recent trends in resistance to cell envelope-active antibacterial agents among key bacterial pathogens. Ann N Y Acad Sci 1277:1–7
Mietto C, Pinciroli R, Patel N et al (2013) Ventilator associated pneumonia: evolving definitions and preventive strategies. Respir Care 58:990–1007
Mietto C, Foley K, Salerno L et al (2014) Removal of endotracheal tube obstruction with a secretion clearance device. Respir Care 59:e122–e126
Mnif B, Ktari S, Chaari A et al (2013) Nosocomial dissemination of Providencia stuartii isolates carrying bla OXA-48, bla PER-1, bla CMY-4 and qnrA6 in a Tunisian hospital. J Antimicrob Chemother 68:329–332
Moellering RC Jr (2012) MRSA: the first half century. J Antimicrob Chemother 67:4–11
Mortensen BL, Skaar EP (2012) Host-microbe interactions that shape the pathogenesis of Acinetobacter baumannii infection. Cell Microbiol 14:1336–1344
Mulcahy LR, Isabella VM, Lewis K (2014) Pseudomonas aeruginosa biofilms in disease. Microb Ecol 68:1–12
Munoz-Price LS, Weinstein RA (2008) Acinetobacter infection. N Engl J Med 358:1271–1281
Ning BT, Zhang CM, Liu T et al (2013) Pathogenic analysis of sputum from ventilator-associated pneumonia in a pediatric intensive care unit. Exp Ther Med 5:367–371
Nordmann P (2013) Carbapenemase-producing Enterobac-teriaceae: overview of a major public health challenge. Med Mal Infect
Oettinger-Barak O, Dashper SG, Catmull DV, et al (2013) Antibiotic susceptibility of Aggregatibacter actinomycetemcomitans JP2 in a biofilm. J Oral Microbiol 5. doi:10.3402/jom.v5i.20320
Oppenheimer-Shaanan Y, Steinberg N, Kolodkin-Gal I (2013) Small molecules are natural triggers for the disassembly of biofilms. Trends Microbiol 21:594–601
Otto M (2009) Staphylococcus epidermidis–the ‘accidental’ pathogen. Nat Rev Microbiol 7:555–567
Otto M (2012) Molecular basis of Staphylococcus epidermidis infections. Semin Immunopathol 34:201–214
Otto M (2013a) Coagulase-negative staphylococci as reservoirs of genes facilitating MRSA infection: Staphylococcal commensal species such as Staphylococcus epidermidis are being recognized as important sources of genes promoting MRSA colonization and virulence. Bioessays 35:4–11
Otto M (2013b) Staphylococcal infections: mechanisms of biofilm maturation and detachment as critical determinants of pathogenicity. Annu Rev Med 64:175–188
Otto M (2014) Staphylococcus epidermidis pathogenesis. Methods Mol Biol 1106:17–31
Palmer M, Costerton W, Sewecke J et al (2011) Molecular techniques to detect biofilm bacteria in long bone nonunion: a case report. Clin Orthop Relat Res 469:3037–3042
Papazian L, Bregeon F, Thirion X et al (1996) Effect of ventilator-associated pneumonia on mortality and morbidity. Am J Respir Crit Care Med 154:91–97
Parahitiyawa NB, Scully C, Leung WK et al (2010) Exploring the oral bacterial flora: current status and future directions. Oral Dis 16:136–145
Parameswarappa J, Basavaraj VP, Basavaraj CM (2013) Isolation, identification, and antibiogram of enterococci isolated from patients with urinary tract infection. Ann Afr Med 12:176–181
Park DR (2005) The microbiology of ventilator-associated pneumonia. Respir Care 50:742–763, discussion 763–5
Park JH, Lee JH, Cho MH et al (2012) Acceleration of protease effect on Staphylococcus aureus biofilm dispersal. FEMS Microbiol Lett 335:31–38
Pasquantonio G, Condo S, Cerroni L et al (2012) Antibacterial activity of various antibiotics against oral streptococci isolated in the oral cavity. Int J Immunopathol Pharmacol 25:805–809
Paterson DL (2000) Recommendation for treatment of severe infections caused by Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs). Clin Microbiol Infect 6:460–463
Peleg AY, Adams J, Paterson DL (2007) Tigecycline Efflux as a Mechanism for Nonsusceptibility in Acinetobacter baumannii. Antimicrob Agents Chemother 51:2065–2069
Pendleton JN, Gorman SP, Gilmore BF (2013) Clinical relevance of the ESKAPE pathogens. Expert Rev Anti Infect Ther 11:297–308
Perkins SD, Woeltje KF, Angenent LT (2010) Endotracheal tube biofilm inoculation of oral flora and subsequent colonization of opportunistic pathogens. Int J Med Microbiol 300:503–511
Perlroth J, Choi B, Spellberg B (2007) Nosocomial fungal infections: epidemiology, diagnosis, and treatment. Med Mycol 45:321–346
Peschel A, Otto M (2013) Phenol-soluble modulins and staphylococcal infection. Nat Rev Microbiol 11:667–673
Petti CA (2007) Detection and identification of microorganisms by gene amplification and sequencing. Clin Infect Dis 44:1108–1114
Pfaller MA (2012) Antifungal drug resistance: mechanisms, epidemiology, and consequences for treatment. Am J Med 125:S3–S13
Pierard GE, Hermanns-Le T, Delvenne P et al (2012) Miconazole, a pharmacological barrier to skin fungal infections. Expert Opin Pharmacother 13:1187–1194
Pihl M, Chavez De Paz LE, Schmidtchen A et al (2010) Effects of clinical isolates of Pseudomonas aeruginosa on Staphylococcus epidermidis biofilm formation. FEMS Immunol Med Microbiol 59:504–512
Pirracchio R, Mateo J, Raskine L et al (2009) Can bacteriological upper airway samples obtained at intensive care unit admission guide empiric antibiotherapy for ventilator-associated pneumonia? Crit Care Med 37:2559–2563
Pittman JE, Calloway EH, Kiser M et al (2010) Age of Pseudomonas aeruginosa acquisition and subsequent severity of cystic fibrosis lung disease. Pediatr Pulmonol [Epub ahead of print]
Pneumatikos IA, Dragoumanis CK, Bouros DE (2009) Ventilator-associated pneumonia or endotracheal tube-associated pneumonia? An approach to the pathogenesis and preventive strategies emphasizing the importance of endotracheal tube. Anesthesiology 110:673–680
Poulain D (2013) Candida albicans, plasticity and pathogenesis. Crit Rev Microbiol [Epub ahead of print]
Purschke FG, Hiller E, Trick I et al (2012) Flexible survival strategies of Pseudomonas aeruginosa in biofilms result in increased fitness compared with Candida albicans. Mol Cell Proteomics 11:1652–1669
Ramage G, Robertson SN, Williams C (2014) Strength in numbers: antifungal strategies against fungal biofilms. Int J Antimicrob Agents 43:114–120
Ramsugit S, Guma S, Pillay B et al (2013) Pili contribute to biofilm formation in vitro in Mycobacterium tuberculosis. Antonie Van Leeuwenhoek 104:725–735
Ready D, Lancaster H, Qureshi F et al (2004) Effect of amoxicillin use on oral microbiota in young children. Antimicrob Agents Chemother 48:2883–2887
Ready D, Pratten J, Roberts AP et al (2006) Potential role of Veillonella spp. as a reservoir of transferable tetracycline resistance in the oral cavity. Antimicrob Agents Chemother 50:2866–2868
Rello J, Ausina V, Ricart M et al (1993) Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia. Chest 104:1230–1235
Roberts CG (2013) The role of biofilms in reprocessing medical devices. Am J Infect Control 41:S77–S80
Rodriguez-Guardado A, Boga JA, Diego ID et al (2005) Clinical characteristics of nosocomial and community-acquired extraintestinal infections caused by Hafnia alvei. Scand J Infect Dis 37:870–872
Rogers KL, Fey PD, Rupp ME (2009) Coagulase-negative staphylococcal infections. Infect Dis Clin North Am 23:73–98
Ronveaux O, Gheldre Y, Glupczynski Y et al (1999) Emergence of Enterobacter aerogenes as a major antibiotic-resistant nosocomial pathogen in Belgian hospitals. Clin Microbiol Infect 5:622–627
Ruben SJ (1993) Rothia dentocariosa endocarditis. West J Med 159:690–691
Ruoff KL (1991) Nutritionally variant streptococci. Clin Microbiol Rev 4:184–190
Safdar N, Dezfulian C, Collard HR et al (2005) Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 33:2184–2193
Sandiumenge A, Rello J (2012) Ventilator-associated pneumonia caused by ESKAPE organisms: cause, clinical features, and management. Curr Opin Pulm Med 18:187–193
Savage VJ, Chopra I, O’neill AJ (2013) Staphylococcus aureus biofilms promote horizontal transfer of antibiotic resistance. Antimicrob Agents Chemother 57:1968–1970
Shah C, Kollef MH (2004) Endotracheal tube intraluminal volume loss among mechanically ventilated patients. Crit Care Med 32:120–125
Shen S, Samaranayake LP, Yip HK (2005) Coaggregation profiles of the microflora from root surface caries lesions. Arch Oral Biol 50:23–32
Shiotsuka J, Lefor AT, Sanui M et al (2012) A quantitative evaluation of fluid leakage around a polyvinyl chloride tapered endotracheal tube cuff using an in-vitro model. HSR Proc Intensive Care Cardiovasc Anesth 4:169–175
Sibley CD, Peirano G, Church DL (2012) Molecular methods for pathogen and microbial community detection and characterization: current and potential application in diagnostic microbiology. Infect Genet Evol 12:505–521
Singhai M, Malik A, Shahid M et al (2012) A study on device-related infections with special reference to biofilm production and antibiotic resistance. J Glob Infect Dis 4:193–198
Siqueira JF Jr, Rocas IN (2013) As-yet-uncultivated oral bacteria: breadth and association with oral and extra-oral diseases. J Oral Microbiol 5. doi:10.3402/jom.v5i.21077
Sisirak M, Hukic M (2013) An outbreak of multidrug-resistant Serratia marcescens: the importance of continuous monitoring of nosocomial infections. Acta Med Acad 42:25–31
Sizova MV, Hohmann T, Hazen A et al (2012) New approaches for isolation of previously uncultivated oral bacteria. Appl Environ Microbiol 78:194–203
Sofianou D, Avgoustinakis E, Dilopoulou A et al (2004) Soft-tissue abscess involving Actinomyces odontolyticus and two Prevotella species in an intravenous drug abuser. Comp Immunol Microbiol Infect Dis 27:75–79
Soto SM (2013) Role of efflux pumps in the antibiotic resistance of bacteria embedded in a biofilm. Virulence 4:223–229
Sottile FD, Marrie TJ, Prough DS et al (1986) Nosocomial pulmonary infection: possible etiologic significance of bacterial adhesion to endotracheal tubes. Crit Care Med 14:265–270
Stoodley P, Sauer K, Davies DG et al (2002) Biofilms as complex differentiated communities. Annu Rev Microbiol 56:187–209
Strateva T, Yordanov D (2009) Pseudomonas aeruginosa – a phenomenon of bacterial resistance. J Med Microbiol 58:1133–1148
Suzumura H, Nitta A, Tanaka G et al (2000) Role of infection in the development of acquired subglottic stenosis in neonates with prolonged intubation. Pediatr Int 42:508–513
Tegmark K, Morfeldt E, Arvidson S (1998) Regulation of agr-dependent virulence genes in Staphylococcus aureus by RNAIII from coagulase-negative staphylococci. J Bacteriol 180:3181–3186
Torres A, Gatell JM, Aznar E et al (1995) Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 152:137–141
Towner KJ (2009) Acinetobacter: an old friend, but a new enemy. J Hosp Infect 73:355–363
Trampuz A, Piper KE, Jacobson MJ et al (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 357:654–663
Trang NH, Nga TV, Campbell JI et al (2013) The characterization of ESBL genes in Escherichia coli and Klebsiella pneumoniae causing nosocomial infections in Vietnam. J Infect Dev Ctries 7:922–928
Tyson GW, Banfield JF (2005) Cultivating the uncultivated: a community genomics perspective. Trends Microbiol 13:411–415
Ulett GC, Totsika M, Schaale K et al (2013) Uropathogenic Escherichia coli virulence and innate immune responses during urinary tract infection. Curr Opin Microbiol 16:100–107
Vandecandelaere I, Matthijs N, Van Nieuwerburgh F et al (2012) Assessment of microbial diversity in biofilms recovered from endotracheal tubes using culture dependent and independent approaches. PLoS ONE 7:e38401
Vandecandelaere I, Matthijs N, Nelis HJ et al (2013) The presence of antibiotic-resistant nosocomial pathogens in endotracheal tube biofilms and corresponding surveillance cultures. Pathog Dis 69:142–148
Vandecandelaere I, Depuydt P, Nelis HJ et al (2014) Protease production by Staphylococcus epidermidis and its effect on Staphylococcus aureus biofilms. Pathog Dis 70:321–331
Vandenbosch D, De Canck E, Dhondt I et al (2013) Genomewide screening for genes involved in biofilm formation and miconazole susceptibility in Saccharomyces cerevisiae. FEMS Yeast Res 13:720–730
Von Eiff C, Proctor RA, Peters G (2001) Coagulase-negative staphylococci. Pathogens have major role in nosocomial infections. Postgrad Med 110:63–64, 69–70, 73–76
Von Gotz F, Haussler S, Jordan D et al (2004) Expression analysis of a highly adherent and cytotoxic small colony variant of Pseudomonas aeruginosa isolated from a lung of a patient with cystic fibrosis. J Bacteriol 186:3837–3847
Wade JJ (1997) Enterococcus faecium in hospitals. Eur J Clin Microbiol Infect Dis 16:113–119
Wang BY, Chi B, Kuramitsu HK (2002) Genetic exchange between Treponema denticola and Streptococcus gordonii in biofilms. Oral Microbiol Immunol 17:108–112
Wang Q, Wright CJ, Dingming H et al (2013) Oral community interactions of Filifactor alocis in vitro. PLoS ONE 8:e76271
Wanner S, Gstottner M, Meirer R et al (2011) Low-energy shock waves enhance the susceptibility of staphylococcal biofilms to antimicrobial agents in vitro. J Bone Joint Surg (Br) 93:824–827
Warburton PJ, Ciric L, Lerner A et al (2013) TetAB46, a predicted heterodimeric ABC transporter conferring tetracycline resistance in Streptococcus australis isolated from the oral cavity. J Antimicrob Chemother 68:17–22
Weber DJ, Rutala WA, Sickbert-Bennett EE et al (2007) Microbiology of ventilator-associated pneumonia compared with that of hospital-acquired pneumonia. Infect Control Hosp Epidemiol 28:825–831
Wellington EM, Boxall AB, Cross P et al (2013) The role of the natural environment in the emergence of antibiotic resistance in gram-negative bacteria. Lancet Infect Dis 13:155–165
Willems RJ, Van Schaik W (2009) Transition of Enterococcus faecium from commensal organism to nosocomial pathogen. Future Microbiol 4:1125–1135
Willner D, Daly J, Whiley D et al (2012) Comparison of DNA extraction methods for microbial community profiling with an application to pediatric bronchoalveolar lavage samples. PLoS ONE 7:e34605
Wilson A, Gray D, Karakiozis J et al (2012) Advanced endotracheal tube biofilm stage, not duration of intubation, is related to pneumonia. J Trauma Acute Care Surg 72:916–923
Wolcott RD, Ehrlich GD (2008) Biofilms and chronic infections. JAMA 299:2682–2684
Wolcott R, Costerton JW, Raoult D et al (2013) The polymicrobial nature of biofilm infection. Clin Microbiol Infect 19:107–112
Wu D, Cai J, Liu J (2011) Risk factors for the acquisition of nosocomial infection with carbapenem-resistant Klebsiella pneumoniae. South Med J 104:106–110
Yang J, Yoshida Y, Cisar JO (2014) Genetic basis of coaggregation receptor polysaccharide biosynthesis in Streptococcus sanguinis and related species. Mol Oral Microbiol 29:24–31
Zanella A, Scaravilli V, Isgro S et al (2011) Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study. Intensive Care Med 37:343–347
Zarrilli R, Giannouli M, Tomasone F et al (2009) Carbapenem resistance in Acinetobacter baumannii: the molecular epidemic features of an emerging problem in health care facilities. J Infect Dev Ctries 3:335–341
Zhao J, Carmody LA, Kalikin LM et al (2012a) Impact of enhanced Staphylococcus DNA extraction on microbial community measures in cystic fibrosis sputum. PLoS ONE 7:e33127
Zhao J, Schloss PD, Kalikin LM et al (2012b) Decade-long bacterial community dynamics in cystic fibrosis airways. Proc Natl Acad Sci U S A 109:5809–5814
Ziebuhr W, Hennig S, Eckart M et al (2006) Nosocomial infections by Staphylococcus epidermidis: how a commensal bacterium turns into a pathogen. Int J Antimicrob Agents 28(Suppl 1):S14–S20
Zolfaghari PS, Wyncoll DL (2011) The tracheal tube: gateway to ventilator-associated pneumonia. Crit Care 15:310
Zur KB, Mandell DL, Gordon RE et al (2004) Electron microscopic analysis of biofilm on endotracheal tubes removed from intubated neonates. Otolaryngol Head Neck Surg 130:407–414
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Vandecandelaere, I., Coenye, T. (2015). Microbial Composition and Antibiotic Resistance of Biofilms Recovered from Endotracheal Tubes of Mechanically Ventilated Patients. In: Donelli, G. (eds) Biofilm-based Healthcare-associated Infections. Advances in Experimental Medicine and Biology, vol 830. Springer, Cham. https://doi.org/10.1007/978-3-319-11038-7_9
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