A silver-coated endotracheal tube may reduce infections with highly resistant bacteria over traditional tubes by nearly half, according to the results of a large randomized trial presented at the American Thoracic Society's 2008 International Conference in Toronto last month.
Patients who are on ventilators are often at risk for developing ventilator-associated pneumonia (VAP) as a result of the resistant bacteria.
"VAP is a serious disease with significant mortality," said lead investigator, Andrew Shorr, M.D., M.P.H., of Washington Hospital Center in Washington, D.C.
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"Crude mortality rates from VAP approach 25 to 30 percent and VAP rates are now thought to reflect hospital quality," Dr. Shorr said. "These infections include highly resistant pathogens, such as methicillin-resistant Staphylococcus aureus or MRSA, which is the most troubling infection and often the hardest to treat.
"The average cost associated with treatment of VAP exceeds $40,000 because of the impact on length of stay in the ICU," Dr. Shorr said.
To test the efficacy of the silver-coated tube in preventing infections, the study included a modified intention-to-treat population of 1,509 patients, balanced between traditional endotracheal tubes and the silver-coated ones.
The researchers used brochoavelolar lavage fluid cultures to ascertain the presence of pathogenic organisms and classified MRSA, Pseudomonas aeruginosa (PA) and Acinetobacter bumanii (AB) as highly resistant pathogens.
They found that VAP in all its forms was reduced by nearly 40 percent in the population with the silver-coated endotracheal tubes and that highly resistant infections were less than half as likely to occur in those patients using the silver-coated tubes.
"What we show in this present analysis is that the silver-coated breathing tube prevents infections due to the most highly resistant pathogens. Other prevention strategies for VAP have not always been shown to affect the rates of infection with these highly-resistant strains," Dr. Shorr told attendees at the meeting.
He concluded that given the likelihood of developing MRSA, PA and AB in the Intensive Care Unit, using the silver-coated endotracheal tube should be considered to be an important preventive device.