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.
