Biofilm on Chest Drains After Thoracic Surgery: Clinical Impact and Antibiotic Resistance

Biofilm Formation on Thoracic Drains: Clinical Significance and Association With Antibiotic Resistance

This prospective observational study aims to investigate the frequency and clinical significance of biofilm formation on thoracic chest drains used after thoracic surgery. Biofilms are structured bacterial communities that adhere to surfaces and can promote infection and antibiotic resistance. In this study, small samples from the tips of chest drains will be collected under sterile conditions at the time of drain removal and analyzed in the microbiology laboratory.

The main objectives are to evaluate the relationship between the duration of chest drain placement and the presence of biofilm, and to identify the antibiotic resistance profiles of microorganisms isolated from these biofilms. Secondary outcomes include the association between biofilm formation, postoperative infections (such as empyema or wound infection), and the length of hospital stay.

This study will be conducted at Ondokuz Mayıs University Faculty of Medicine, Department of Thoracic Surgery, in collaboration with the Department of Microbiology. The findings are expected to contribute to better understanding of optimal drain management and infection prevention strategies after thoracic surgery.

Study Overview

• Status: Recruiting
• Conditions: Postoperative Infection; Thoracic Surgery; Biofilms; Antibiotic Resistance, Bacterial
• Intervention / Treatment: Other: Chest Drain Tip Sampling

• Study Type: Observational
• Enrollment (Estimated): 180

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Samsun
    • Samsun, Samsun, Turkey (Türkiye), 55139
      • Recruiting
      • Ondokuz Mayis University Medical Faculty, Department of Thoracic Surgery
      • Contact: Caner İşevi, MD; Phone Number: 4240 03623121919; Email: drcanerisevi@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Adult patients (≥18 years old) who undergo elective thoracic surgery at Ondokuz Mayıs University Faculty of Medicine and require postoperative chest drain placement. Participants are prospectively enrolled and observed until drain removal. Drain tip samples are collected for microbiological and biofilm analysis.

Description

Inclusion Criteria:

• Age 18 years and older
• Undergoing elective thoracic surgery requiring chest drain placement
• Able and willing to provide written informed consent

Exclusion Criteria:

• Presence of active infection prior to surgery
• Emergency thoracic surgery
• Immunosuppressed patients (e.g., neutropenia, advanced malignancy, organ transplantation)
• Patients receiving systemic antibiotic therapy at the time of drain removal
• Drainage for empyema or pre-existing pleural infection
• Presence of extrathoracic infection focus
• Refusal or inability to provide informed consent

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Group 1 -Short Drain Duration (≤2 Days); Participants whose thoracic chest drains were removed within 2 days after surgery. Drain tip samples from these patients will be analyzed for biofilm formation and microbiological culture.	Other: Chest Drain Tip Sampling; No active intervention; routine chest drain removal followed by microbiological and biofilm analysis of drain tip samples.
Group 2 - Moderate Drain Duration (3-4 Days); Participants whose thoracic chest drains remained in place for 3 to 4 days postoperatively. Drain tips will be examined for biofilm presence and bacterial growth patterns.	Other: Chest Drain Tip Sampling; No active intervention; routine chest drain removal followed by microbiological and biofilm analysis of drain tip samples.
Group 3 - Long Drain Duration (≥5 Days); Participants with chest drains in place for 5 days or longer. Biofilm formation, bacterial species identification, and antibiotic resistance profiles will be evaluated.	Other: Chest Drain Tip Sampling; No active intervention; routine chest drain removal followed by microbiological and biofilm analysis of drain tip samples.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Presence and Intensity of Biofilm Formation on Chest Drain Tips	Biofilm formation on the inner surface of chest drain tips will be evaluated using a microplate crystal violet staining method. The optical density (OD) at 492 nm will be measured, and biofilm intensity will be classified according to the Christensen and Chusri scale (non, weak, moderate, strong). The proportion of patients with biofilm-positive drain tips will be recorded and compared across drain duration groups.	At the time of chest drain removal (postoperative days 1-7)

Collaborators and Investigators

• Sponsor: Caner İşevi, MD

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2025
• Primary Completion (Estimated): March 1, 2026
• Study Completion (Estimated): July 1, 2026

Study Registration Dates

• First Submitted: November 13, 2025
• First Submitted That Met QC Criteria: November 13, 2025
• First Posted (Estimated): November 14, 2025

Study Record Updates

• Last Update Posted (Actual): November 19, 2025
• Last Update Submitted That Met QC Criteria: November 16, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Other Study ID Numbers: B.30.2.ODM.0.20.08/600-660

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared because the dataset includes sensitive clinical and microbiological information collected from a single-center study. Data will be used only for the approved research protocol and analyzed in aggregate form to protect participant confidentiality in accordance with institutional and national data protection regulations.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No