Endotracheal Tube Associated Microbiome in the Intensive Care Unit

Abstract

Background: Exploration of the microbiome within the respiratory tract predominantly centers on the diversity of microorganisms in the airways and lungs. However, there remains a lack of clarity regarding the potential impact of intubation and prolonged stays in intensive care units (ICU) on these microbial communities. Aim of the study: The present investigation sought to examine and characterize the microbiome of endotracheal tubes (ETT), along with assessing their susceptibility and resistance to antimicrobial agents. Patients and methods: This 12-month cross-sectional study, conducted in the ICU department of Baghdad Teaching Hospital, focused on forty adult patients (aged 18 and above) undergoing mechanical ventilation for diverse reasons. Notably, exclusion criteria involved individuals intubated for less than 3 days or more than 14 days. The research involved collecting data on demographics and the duration of endotracheal tube placement. Additionally, a thorough bacterial culture and sensitivity analysis was conducted on samples obtained from the endotracheal tube. Results: In a cohort with a mean age of 48.6 years (SD: 20.0), comprising 67.5% males and 32.5% females, the average duration of endotracheal intubation was 7.3 days (SD: 2.7). Klebsiella pneumoniae prevailed in bacterial cultures (37.5%), followed by Acinetobacter baumannii (15.0%). Fungal cultures were mostly negative (97.5%), with Saprochaete capitata detected in 2.5% of cases. Overall sensitivity was 85%, with amikacin at 37.5%, gentamicin at 25.0%, and cefepime, colistin, minocycline, and piperacillin-tazobactam at 17%. Multi-drug resistance was identified in one pseudomonas and three klebsiella pneumonia cases. Conclusion: The study revealed Klebsiella pneumoniae as the predominant pathogen in endotracheal tube cultures, followed by Acinetobacter. High drug sensitivity, especially to Amikacin, was observed, with limited instances of multi-drug resistance (MDR) in Klebsiella pneumoniae cultures