Dautle Melanie P, Wilkinson T Ross, Gauderer Michael W L
Department of Microbiology and Molecular Medicine, Clemson University, Clemson, SC, USA.
J Pediatr Surg. 2003 Feb;38(2):216-20. doi: 10.1053/jpsu.2003.50046.
BACKGROUND/PURPOSE: Silicone gastrostomy devices (tubes and "buttons") are used extensively for long-term feeding and administration of special diets and medications. However, their potential for harboring microorganisms and possibly compromising the host largely is unknown. This study was conducted to isolate and identify the microbial species in viable biofilms attached to these devices in a pediatric cohort.
A total of 78 domains on 18 silicone gastrostomy devices (12 "buttons" and 6 tubes converted to skin level devices), previously used for feeding (3 to 47 months) in children ranging in age from 6 months to 17 years were analyzed for microbial content. Biofilms were removed from the silicone tube surfaces and inoculated into enriched nutrient media using standard procedures. Intact biofilms also were observed using scanning electron microscopy (SEM) and confocal scanning laser microscopy.
All devices analyzed in this investigation were found to exhibit biofilm growth. Of the 24 identified bacterial species, the predominant genera included Bacillus, Enterococcus, and Staphylococcus. Control studies of the tubes under SEM showed a multitude of crevices serving as niches for microbial colonization. Observation of the attached biofilm by SEM showed various biomasses with numerous morphologies.
Biofilm composition and attachment to silicone enteral access devices has not received appropriate attention previously. This study shows that devices are colonized with various bacteria and fungi posing a potential threat to patients, particularly those who are immunocompromised. These microorganisms also may play a significant role in the formation of granulation tissue and contribute to device failure.
背景/目的：硅胶胃造口术装置（管道和“纽扣”）广泛用于长期喂养以及特殊饮食和药物的给药。然而，其携带微生物并可能危害宿主的可能性在很大程度上尚不清楚。本研究旨在分离并鉴定儿科队列中附着于这些装置的活生物膜中的微生物种类。
对18个硅胶胃造口术装置（12个“纽扣”和6个转换为皮肤水平装置的管道）上总共78个区域进行了微生物含量分析，这些装置先前用于6个月至17岁儿童的喂养（3至47个月）。使用标准程序从硅胶管表面去除生物膜并接种到富集营养培养基中。还使用扫描电子显微镜（SEM）和共聚焦扫描激光显微镜观察完整的生物膜。
本研究分析的所有装置均显示有生物膜生长。在鉴定出的24种细菌中，主要菌属包括芽孢杆菌属、肠球菌属和葡萄球菌属。SEM下对管道的对照研究显示有许多缝隙可作为微生物定植的生态位。通过SEM观察附着的生物膜显示出具有多种形态的各种生物量。
生物膜组成以及与硅胶肠内接入装置的附着情况此前未得到适当关注。本研究表明，这些装置被各种细菌和真菌定植，对患者构成潜在威胁，尤其是免疫功能低下的患者。这些微生物也可能在肉芽组织形成中起重要作用，并导致装置失效。
