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An endotracheal (ET) tube offers surface for potential pathogens to attach and produce biofilm. These potential pathogens are typically hospital flora with a broad range of antibiotic resistance. The study aimed to characterize the biofilm-producing flora in ET tube of critically ill patients. Following extubation, ET tubes were retrieved aseptically from 100 different patients and promptly transported in a sterile ziplock bag. Each ET tube was cut into three different sections; inner lumen was scraped out and inoculated on Blood agar, MacConkey agar, and Chocolate agar. Colonies produced on media were tested for antibiotic susceptibility testing by applying disc diffusion and Colistin minimum inhibitory concentration (MIC). Out of 100 ET tubes, monomicrobial growth was observed in 62, polymicrobial growth in 14, and no growth in 24 specimens. A total of 93 potential pathogens were isolated including 25 (26.89%) Acinetobacter species, 23 (24.73%) Klebsiella species, 15(16.12%) Pseudomonas species, 13 (13.98%) E. coli, 6 (6.45%), Staphylococcus aureus, 4 (4.3%) Coagulase Negative Staphylococcus species (CoNS), 2 (2.15%) Proteus species, 1 (1.07%) Enterobacter species and 4 (4.3%) Candida species. Imipenem and Colistin proved to be among the most successful antibiotics against gram negative isolates. Only 1 out of 25 Acinetobacter species was resistant to Colistin. Methicillin resistance emerged in two S. aureus and three CoNS strains. Microorganisms usually adhere themselves to the surface of ET tubes. They may act as potential pathogens for the onset of Ventilator Associated Pneumonia (VAP) and are resistant to commonly administered antibiotics in hospitals. A technique to reduce or prevent the risk of biofilm development is crucial.

Gastrointestinal (GI) involvement of cytomegalovirus (CMV) infection is being recognized with increased frequency in patients with acquired immunodeficiency syndrome (AIDS). Oesophagitis is the second most common GI manifestation of CMV infection after colitis. We describe a case of severe human CMV oesophagitis in a patient with human immunodeficiency virus (HIV) infection. This patient was successfully treated with ganciclovir.

Introduction: The potential pathogens of ventilator associated pneumonia (VAP) have the ability to form biofilm within the endotracheal (ET) tube inserted in a patient. These pathogens can lead to onset of VAP once they are flushed into the lungs during mechanical ventilation. Methodology: A prospective study was conducted where ETtubes were collected from the patients in ICU after more than 48 hours of intubation. ET tube was cut into sections and inner lumen was scrapped. The material was inoculated on 5% sheep blood agar and MacConkey agar. The isolated pathogens were tested for identification and antibiotic susceptibility testing. Bacterial isolates were also tested for in-vitro biofilm formation in microtiter plate by 1% crystal violet assay. Results: Among the 100 ET tubes, 93 microorganisms were isolated which include 79 (84.9%) gram negative bacilli (GNB), 10 (10.8%) gram positive cocci (GPC), and 4 (4.3%) yeasts. Most common isolates were Acinetobacter species, Klebsiella species, Pseudomonas species, and E coli. Out of 10 GPC isolates, six were identified as Methicillin resistant strains including 4 (66.7%) coagulase negative Staphylococcus species and 2 (33.3%) S aureus. Out of 79 GNBs, 16 (20.3%) were extended spectrum beta lactomase (ESBL) producers, 14 (17.7%) AmpC, and 16 (20.3%) were carbapenemase producers. Carbapenemase production was further identified as metallo beta lactamase (MBL) producers (n=10) and serine carbapenemase producers (n=6). Out of 89 bacterial isolates, 82 (92.1%) were tested positive for in-vitro biofilm production while 07 (7.9%) were identified as non-adherent. Conclusion: Most of the ET tubes inserted for more than 48 hours inside a patient have a high risk of getting infested with potential biofilm producing pathogen. There is high rate of multi drug resistant (MDR) strains among these potential pathogens. The biofilm formed inside the ETtube possess the risk of onset of VAP.