Correlation Between Bacterial Count and Duration of Tracheostomy Tubes Use
DOI:
https://doi.org/10.36408/mhjcm.v13i1.1232Keywords:
Bacterial count, biofilm, infection control, Pseudomonas aeruginosa, tracheostomy tubeAbstract
BACKGROUND: Tracheostomy tubes (TTs) are life-sustaining medical devices widely used for patients with upper airway obstruction or requiring prolonged mechanical ventilation. However, TTs serve as an indwelling substrate that promotes bacterial colonization and biofilm formation, particularly by resistant pathogens such as Pseudomonas aeruginosa and Staphylococcus aureus. Despite the well-recognized clinical risks, evidence correlating the duration of TT use with quantitative bacterial load in the Indonesian hospital setting remains limited, creating a gap in local clinical guidance for tube replacement scheduling.
AIM: To analyze the correlation between TT duration of use and bacterial colony count (CFU/mL), and to identify the predominant colonizing pathogens in order to inform evidence-based infection prevention and tube replacement timing.
METHOD: This cross-sectional observational study was conducted from July 2020 to January 2021 at Dr. Sardjito General Hospital, Yogyakarta, Indonesia. A total of 20 polyvinyl chloride (PVC) Portex™ tracheostomy tubes were collected via consecutive sampling from patients undergoing decannulation procedures. Bacterial cultures were performed at the Department of Microbiology, Universitas Gadjah Mada, with bacterial load expressed as colony-forming units per milliliter (CFU/mL). Spearman’s rank correlation was used for statistical analysis.
RESULTS: Mean bacterial counts (CFU × 10³/mL) were 48.5, 9,853.83, and 28,200.00 for TT use durations of <30 days, 30–90 days, and >90 days, respectively. Spearman’s rank correlation demonstrated a strong positive association between duration and bacterial count (r = 0.70, p = 0.01). Pseudomonas aeruginosa was the most prevalent organism, identified in 60% of tubes.
CONCLUSION: Duration of TT use exceeding 30 days is significantly correlated with higher bacterial colonization burden. Pseudomonas aeruginosa was the predominant pathogen. These findings support the recommendation for scheduled TT replacement within 30 days as an infection control measure in tracheostomized patients.
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References
1. Raveendra N, Rathnakara SH, Haswani N, Subramaniam V. Bacterial biofilms on tracheostomy tubes. Indian J Otolaryngol Head Neck Surg. 2022;74(S3):4995–4999.
2. Săndulescu O. Managing sticky situations – anti-biofilm agents. Germs. 2016;6(2):49–57.
3. Deshmukh-Reeves E, Shaw M, Bilsby C, Gourlay CW. Biofilm formation on endotracheal and tracheostomy tubing: a systematic review and meta-analysis of culture data and sampling method. MicrobiologyOpen. 2025;14:e70032.
4. Mishra SK, Baidya S, Bhattarai A, Shrestha S, Homagain S, Rayamajhee B, Hui A, Willcox M. Bacteriology of endotracheal tube biofilms and antibiotic resistance: a systematic review. J Hosp Infect. 2024;147:146–157. doi:10.1016/j.jhin.2024.03.004.
5. Taner F, Baddal B, Theodoridis L, Petrovski S. Biofilm production in intensive care units: challenges and implications. Pathogens. 2024;13(11):954. doi:10.3390/pathogens13110954.
6. Maldiney T, Pineau V, Neuwirth C, et al. Endotracheal tube biofilm in critically ill patients during the COVID-19 pandemic: description of an underestimated microbiological compartment. Sci Rep. 2022;12:22389. doi:10.1038/s41598-022-26560-w.
7. Sharma S, Mohler J, Mahajan SD, et al. Microbial biofilm: a review on formation, infection, antibiotic resistance, control measures, and innovative treatment. Microorganisms. 2023;11(6):1614.
8. Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020;46(5):888–906.
9. Ścibik Ł, Ochońska D, Gołda-Cępa M, Kotarba A, Brzychczy-Włoch M. Microbiological analysis of tracheostomy tube biofilms and antibiotic resistance profiles of potentially pathogenic microorganisms. Otolaryngol Pol. 2022;76(5):1–14.
10. Badal D, Jayarani AV, Kollaran MA, et al. Pseudomonas aeruginosa biofilm formation on endotracheal tubes requires multiple two-component systems. J Med Microbiol. 2020;69(6):906–919.
11. Hutauruk SM, Hermani B, Monasari P. Role of chlorhexidine on tracheostomy cannula decontamination in relation to the growth of biofilm-forming bacteria colony: a randomized controlled trial study. Ann Med Surg (Lond). 2021;67:102491.
12. Backman S, Björling G, Johansson UB, Lysdahl M, Markström A, Schedin U, et al. Material wear of polymeric tracheostomy tubes: a six-month study. Laryngoscope. 2009;119(4):657–664.
13. Limoli DH, Jones CJ, Wozniak DJ. Bacterial extracellular polysaccharides in biofilm formation and function. Microbiol Spectr. 2015;3(3):1–19.
14. Bouhrour N, Nibbering PH, Bendali F. Medical device-associated biofilm infections and multidrug-resistant pathogens. Pathogens. 2024;13(5):393.
15. Alrabiah A, Alhussinan K, Alyousef M, et al. Microbiological profiles of tracheostomy patients: a single-center experience. Multidiscip Respir Med. 2021;16:811.
16. Kumarasinghe D, Wong EH, Duvnjak M, Smith MC, Palme CE, Riffat F. Colonization rates of tracheostomy tubes associated with the frequency of tube changes. ANZ J Surg. 2020;90(12):2310–2314.
17. Saravanam PK, Jayagandhi S, Shajahan S. Microbial profile in tracheostomy tube and tracheostoma: a prospective study. Indian J Otolaryngol Head Neck Surg. 2022;74(S2):1740–1743.
18. Lepainteur M, Ogna A, Clair B, et al. Risk factors for respiratory tract bacterial colonization in adults with neuromuscular or neurological disorders and chronic tracheostomy. Respir Med. 2019;152:32–36.
19. Reynolds D, Kollef M. The epidemiology and pathogenesis and treatment of Pseudomonas aeruginosa infections: an update. Drugs. 2021;81(18):2117–2131. doi:10.1007/s40265-021-01635-6.
20. Tamma PD, Heil EL, Justo JA, Mathers AJ, Satlin MJ, Bonomo RA. Infectious Diseases Society of America 2024 guidance on the treatment of antimicrobial-resistant gram-negative infections. Clin Infect Dis. 2024;ciae403. doi:10.1093/cid/ciae403.
21. Karruli A, Catalini C, D'Amore C, Foglia F, Mari F, Harxhi A, Galdiero M, Durante-Mangoni E. Evidence-based treatment of Pseudomonas aeruginosa infections: a critical reappraisal. Antibiotics (Basel). 2023;12(2):399. doi:10.3390/antibiotics12020399.
22. Pearce H, Talks BJ, Powell S, Brodlie M, Powell J. A systematic review of antimicrobial therapy in children with tracheostomies. Pediatr Pulmonol. 2024;59(2):251–259. doi:10.1002/ppul.26766.
23. McGrath BA, Brenner MJ, Warrillow SJ, et al. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Lancet Respir Med. 2020;8(7):717–725.
24. Vestby LK, Grønseth T, Simm R, et al. Bacterial biofilm and its role in the pathogenesis of disease. Antibiotics (Basel). 2020;9(2):59.
25. Chen X, Ling X, Liu G, Xiao J. Antimicrobial coating: tracheal tube application. Int J Nanomedicine. 2022;17:1483–1494.
26. Ochońska D, Ścibik Ł, Brzychczy-Włoch M. Biofilm formation of clinical Klebsiella pneumoniae strains isolated from tracheostomy tubes and their association with antimicrobial resistance, virulence and genetic diversity. Pathogens. 2021;10(10):1345.
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