The longer the animal survived, the more Estrogen antagonist biofilm can be found within the ETT internal surface. Furthermore, during ineffective antimicrobial therapy, the severity of infection increases, more mucus is produced and, consequently, more biofilm accumulates within the tube. Indeed, in the control group, animals survived less in comparison with animals treated with linezolid (Table 1). However, in the latter group, linezolid achieved better rate of bacterial killing limiting bacterial biofilm development. In contrast, as a result

of the worse penetrability of vancomycin vs. linezolid into the respiratory secretions, pulmonary tissue, or biofilm (Cruciani et al., 1996; Jefferson et al., 2005), higher clumps of bacterial biofilm were found within the vancomycin group (Table 2). Vancomycin group had also the highest mean of total area analyzed as images depended on the amount of information available in each sample (Table 2). Furthermore, sublethal doses of vancomycin have recently been associated with increased biofilm production by Staphylococcus aureus, because of autolysis and eDNA release (Fig. 4; Hsu et al., 2011). Previous results of this animal model are consistent with our CLSM findings and confirm greater antimicrobial Barasertib price efficacy of linezolid likely due to its pharmacokinetic/pharmacodynamic (PK/PD) profile (Martinez-Olondris

et al., 2012). As clearly emphasized by experts on this field, in vivo biofilm models are necessary to better understand the implications of biofilms in human infections (Hall-Stoodley & Stoodley, 2009). As described by our findings, the use of CLSM in vivo provides essential information on the three-dimensional biofilm structure within the ETT internal lumen and potentially the intensity of the immune response. Of note, we observed biofilm clusters adherent and detached to the ETT surface (Figs 3-7). Other authors have previously described non-adherent bacterial aggregates (Lam et al., 1980; Singh et al., 2000; Worlitzsch et al.,

2002; Fux et al., 2004). Indeed, several studies Montelukast Sodium clearly described biofilm growing inside mucus in patients with cystic fibrosis (Yang et al., 2008; Hassett et al., 2010). Furthermore, the presence of mucus could enhance production of biofilm not necessarily attached to ETT surface (Landry et al., 2006). Thus, although further corroboration is needed, our findings imply greater risks for bacterial translocation into the airways. Additionally, considering that biofilm could develop associated with but not directly adherent to the ETT surface, the efficacy of ETT coated with antimicrobial agents could be reduced. A few potential limitations of this study deserve further clarification. First, although we analyzed a considerable number of images, we only analyzed a small number of ETT samples. Yet, results obtained are consistent with previous findings on this animal model.