{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T20:37:31Z","timestamp":1789591051254,"version":"build-2803163510"},"reference-count":36,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,25]],"date-time":"2025-01-25T00:00:00Z","timestamp":1737763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background\/Objectives: Ventilator-associated pneumonia (VAP) remains a critical challenge in ICU settings, often driven by the biofilm-mediated bacterial colonization of endotracheal tubes (ETTs). This study investigates antimicrobial resistance patterns and biofilm dynamics in ICU patients, focusing on microbial colonization and resistance trends in tracheal aspirates and endotracheal tube biofilms at a county emergency hospital in Romania. Methods: We conducted a longitudinal analysis of ICU patients requiring mechanical ventilation for more than 48 h. Tracheal aspirates and ETT biofilms were collected at three key time points: T1 (baseline), T2 (48 h post-intubation with ETT replacement), and T3 (92\u2013100 h post-T2); these were analyzed using sonication and microbiological techniques to assess microbial colonization and antimicrobial resistance patterns. Results: In a total of 30 patients, bacteria from the ESKAPEE group (e.g., Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus) dominated the microbiota, increasing their prevalence over time. Resistance to carbapenems, colistin, and vancomycin was notably observed, particularly among K. pneumoniae and A. baumannii. Biofilm analysis revealed high persistence rates and the emergence of multidrug-resistant strains, underscoring the role of ETTs as reservoirs for resistant pathogens. The replacement of ETTs at T2 correlated with a shift in microbial composition and reduced biofilm-associated contamination. Conclusions: This study highlights the temporal evolution of antimicrobial resistance and biofilm-associated colonization in a limited number of ICU patients (30 patients). The findings support implementing routine ETT management strategies, including scheduled replacements and advanced biofilm-disruption techniques, to mitigate VAP risk and improve patient outcomes.<\/jats:p>","DOI":"10.3390\/ph18020161","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T04:59:10Z","timestamp":1737953950000},"page":"161","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Antimicrobial Resistance Patterns and Biofilm Analysis via Sonication in Intensive Care Unit Patients at a County Emergency Hospital in Romania"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2381-5577","authenticated-orcid":false,"given":"Ioana Roxana","family":"Codru","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania"},{"name":"County Clinical Emergency Hospital, 2\u20134, Corneliu Coposu Bld., 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6264-064X","authenticated-orcid":false,"given":"Bogdan Ioan","family":"Vintil\u0103","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania"},{"name":"County Clinical Emergency Hospital, 2\u20134, Corneliu Coposu Bld., 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7739-1685","authenticated-orcid":false,"given":"Alina Simona","family":"Bereanu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania"},{"name":"County Clinical Emergency Hospital, 2\u20134, Corneliu Coposu Bld., 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4482-2618","authenticated-orcid":false,"given":"Mihai","family":"Sava","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania"},{"name":"County Clinical Emergency Hospital, 2\u20134, Corneliu Coposu Bld., 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livia Mirela","family":"Popa","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania"},{"name":"County Clinical Emergency Hospital, 2\u20134, Corneliu Coposu Bld., 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7391-3394","authenticated-orcid":false,"given":"Victoria","family":"Birlutiu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania"},{"name":"County Clinical Emergency Hospital, 2\u20134, Corneliu Coposu Bld., 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1093\/cid\/ciw353","article-title":"Management of Adults with Hospital-Acquired and Ventilator-Associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society","volume":"63","author":"Kalil","year":"2016","journal-title":"Clin. 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