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Thursday, October 27, 2016

Extending the life span of tracheoesophageal voice prosthesis (TEP) by oral decontamination that reduces biofilm formation.

Somogyi-Ganss and colleges of the University of Texas MD Anderson Cancer Center, Houston, investigated the patterns of tracheoesophageal voice prosthesis (TEP) and oral colonization with microorganisms, and recorded changes in TEP device life after targeted decontamination between 2003 and 2013. 

Two subgroups were evaluated: (1) patients with microbial analysis of the TEP and the mouth were analyzed to identify patterns of common contamination, and (2) patients who were prescribed targeted oral decontamination with topical or oral antimicrobials on the basis of the microbial analysis of the VP were analyzed to evaluate effects on device life.

Among 42 patients, 3 patients had only fungal, 5 only bacterial, and 33 had colonization with multiple species of fungi and bacteria. In the TEP-oral micro-flora subgroup (n = 15), 7 had common microorganisms in the mouth and on the TEP. Among the decontamination subgroup (n = 23), 6 patients received broad spectrum rinse, 16 anti-fungal agents and 13 antibiotics, or a combination thereof. After targeted decontamination, the median device life of prostheses improved from 7.89 to 10.82 weeks (p = 0.260). The majority of patients with a short TEP device life in this pilot had colonization with multiple species of bacteria and fungi. TEPs rarely had fungal contamination alone (3 %), and non-Candida albicans species were more common than expected. For these reasons, the investigators explored the use of targeted decontamination regimens that were associated with 1.4-fold improvement in TEP duration.

These findings suggest that reducing the colonization of TEPs by microorganisms can extend their useful lifespan.