Selective decontamination of the digestive tract (SDD) does not prevent the formation of microbial biofilms on endotracheal tubes

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Abstract
The purpose of selective decontamination of the digestive tract (SDD) is to eradicate potentially disease-producing micro-organisms from the oropharynx and gastrointestinal tract of intensive care unit (ICU) patients, thereby reducing the incidence of nosocomial sepsis, particularly pneumonia. Microbial biofilms form on endotracheal (ET) tubes even when SDD is being administered and may represent a persistent focus for infection. The aim of this investigation was to determine the susceptibilities of organisms adherent to ET tubes to SDD antibiotics (amphotericin B, tobramycin and polymyxin) and to measure the concentrations of these agents in the tracheal aspirates of 11 patients who were being mechanically ventilated. Following extubation, a section was cut from the tip of each ET tube and any adherent microorganisms subsequently isolated were identified and their MICs determined. Samples of tracheal aspirate were obtained three hours after administration of the SDD regimen and the concentrations of the constituent antimicrobials were measured. Entobacteriaceae were not recovered from any of the tubes but six strains of Staphylococcus aureus, three Pseudomonas spp., three enterococci and four yeasts were isolated. Wide variations in the concentrations of all antibiotics were observed and in many cases they were below the MICs for the organisms isolated. In particular, tobramycin concentrations were uniformly less than the median MIC for the S. aureus isolates and this may account for the predominance of Gram-positive bacteria adherent to the ET tubes. Microbial biofilms attached to these tubes may have a role in the pathogenesis of nosocomial pneumonia in ICU patients.

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