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Research ArticleOriginal Studies

The Antimicrobial Effect of Nitric Oxide on the Bacteria That Cause Nosocomial Pneumonia in Mechanically Ventilated Patients in the Intensive Care Unit

Bevin B McMullin, Dean R Chittock, Diane L Roscoe, Harjinder Garcha, Lexin Wang and Christopher C Miller
Respiratory Care November 2005, 50 (11) 1451-1456;
Bevin B McMullin
Respiratory Services, Vancouver Coastal Health at University of British Columbia, Canada, and with Charles Sturt University, Wagga Wagga, New South Wales, Australia.
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  • For correspondence: [email protected]
Dean R Chittock
Department of Critical Care Medicine, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health, and the University of British Columbia, Vancouver, British Columbia, Canada
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Diane L Roscoe
Department of Medical Microbiology and Infection Control, Vancouver Coastal Health at Vancouver General Hospital and at University of British Columbia, Vancouver, British Columbia, Canada
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Harjinder Garcha
Department of Microbiology, Vancouver Coastal Health at Vancouver General Hospital, Vancouver, British Columbia, Canada
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Lexin Wang
Department of Clinical Pharmacology, Charles Sturt University, Wagga Wagga, New South Wales, Australia
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Christopher C Miller
Pulmonox Medical Inc, Tofield, Alberta, Canada, and with the Department of Experimental Medicine, University of British Columbia, Vancouver, Canada
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Abstract

BACKGROUND: Nosocomial pneumonia is the second most frequent nosocomial infection and the leading cause of death from hospital-acquired infection. Endogenously produced nitric oxide is an important component of the body's natural defense mechanism. Recent studies have demonstrated that exogenous gaseous nitric oxide (gNO) is bactericidal and that inhaled gNO is beneficial to bacterial clearance.

OBJECTIVE: Determine the antimicrobial effect of exogenous gNO in vitro against organisms from culture collections and pathogens derived from tracheal aspirates of mechanically ventilated patients with pneumonia in an intensive care unit.

METHODS: Using bacterial isolates in pure culture, a 0.5 McFarland standard (108 colony-forming-units [cfu] per mL) was prepared and further diluted to 1:1,000 with saline, to 105 cfu/mL. For each isolate tested, 3 mL was pipetted into each well of a 6-well plate, and placed in a specially designed incubator with compartments for both a treatment arm and a control arm. Both chambers received a continuous flow of heated, humidified gas. The treatment chamber had 200 ppm of gNO in the gas flow, which is higher than the clinically accepted concentration for gNO. Samples were drawn off at time intervals, plated onto Columbia agar base with 5% sheep blood, and placed in a traditional incubator at 35°C for a minimum of 24 h. All tests were performed in duplicate. The colony-forming units were visually counted to determine percentage kill.

RESULTS: There was total kill (100% of all colony-forming units) of each bacterial strain subjected to the test conditions at between 2 and 6 h of exposure to 200 ppm gNO.

CONCLUSION: gNO is bactericidal against various strains of bacteria suspended in saline, including both Gram-positive and Gram-negative organisms, and those that commonly cause nosocomial pneumonia in mechanically ventilated patients. Future work should focus on developing strategies that maximize the antimicrobial effect while minimizing the effect of these same interventions on host cells.

  • nitric oxide
  • bacteria
  • pneumonia
  • nosocomial
  • antimicrobial
  • bactericidal

Footnotes

  • Correspondence: Bevin B McMullin MSc RRT, Respiratory Services, Vancouver Coastal Health, Room 203, Koerner Pavilion, 2211 Westbrook Mall, Vancouver BC V6T 2B5, Canada. E-mail: Bevin.McMullin{at}vch.ca.
  • Copyright © 2005 by Daedalus Enterprises Inc.
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Respiratory Care: 50 (11)
Respiratory Care
Vol. 50, Issue 11
1 Nov 2005
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The Antimicrobial Effect of Nitric Oxide on the Bacteria That Cause Nosocomial Pneumonia in Mechanically Ventilated Patients in the Intensive Care Unit
Bevin B McMullin, Dean R Chittock, Diane L Roscoe, Harjinder Garcha, Lexin Wang, Christopher C Miller
Respiratory Care Nov 2005, 50 (11) 1451-1456;

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The Antimicrobial Effect of Nitric Oxide on the Bacteria That Cause Nosocomial Pneumonia in Mechanically Ventilated Patients in the Intensive Care Unit
Bevin B McMullin, Dean R Chittock, Diane L Roscoe, Harjinder Garcha, Lexin Wang, Christopher C Miller
Respiratory Care Nov 2005, 50 (11) 1451-1456;
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Keywords

  • nitric oxide
  • bacteria
  • pneumonia
  • nosocomial
  • antimicrobial
  • bactericidal

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