Biofilms and Infection in Dialysis Patients

Dasgupta, Mrinal

doi:10.1046/j.1525-139x.2002.00084.x

Cited by 87 publications

(69 citation statements)

References 78 publications

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“…This finding differs from the observed in S. aureus episodes, in which b-hemolysin production was a predictor of a poor outcome (11). Even we have not used techniques for direct observation of biofilm, the presence of icaAD was associated with relapse and repeat peritonitis, reinforcing that biofilm increases the risk for relapse (41). However, its association with repeated infections was not previously reported.…”

Section: Discussionmentioning

confidence: 76%

Peritoneal Dialysis–Related Peritonitis due to Coagulase-Negative Staphylococcus

Camargo

Cunha

Júnior

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Coagulase-negative Staphylococcus (CNS) is the most frequent cause of peritoneal dialysis (PD)-related peritonitis in many centers. This study aimed to describe clinical and microbiologic characteristics of 115 CNS episodes and to determine factors influencing the outcome.Design, setting, participants, & measurements This study reviewed the records of 115 CNS peritonitis episodes that occurred in 74 patients between 1994 and 2011 at a single university center. Peritonitis incidences were calculated for three consecutive 6-year periods (P1, 1994-1999; P2, 2000-2005; P3, 2006-2011) and annually. The production of biofilms, enzymes, and toxins was evaluated. Oxacillin resistance was evaluated based on its minimum inhibitory concentration and the presence of the mecA gene.Results The overall incidence of CNS peritonitis was 0.15 episodes per patient per year and did not vary over time (0.12, 0.14, and 0.16 for P1, P2, and P3, respectively; P=0.21). The oxacillin resistance rate was 69.6%. Toxin and enzyme production was infrequent and 36.5% of CNS strains presented the gene encoding biofilm production. The presence of icaAD genes associated with biofilm production was predictive of relapses or repeat episodes (odds ratio [OR], 2.82; 95% confidence interval [95% CI], 1.11 to 7.19; P=0.03). Overall, 70 episodes (60.9%) resolved; oxacillin susceptibility (OR, 4.41; 95% CI, 1.48 to 13.17; P=0.01) and vancomycin use as the first treatment (OR, 22.27; 95% CI, 6.16 to 80.53; P,0.001) were the only independent predictors of resolution.Conclusions Oxacillin resistance and vancomycin use as the first treatment strongly influence the resolution rate in CNS peritonitis, which reinforces the validity of the International Society for Peritoneal Dialysis guidelines on monitoring bacterial resistance to define protocols for initial treatment. These results also suggest that the presence of biofilm is a potential cause of repeat peritonitis episodes.

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Section: Discussionmentioning

confidence: 76%

Peritoneal Dialysis–Related Peritonitis due to Coagulase-Negative Staphylococcus

Camargo

Cunha

Júnior

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…The relevance in the formation of biofilms is in its greater resistance to disinfection processes and the constant presence of micro-organisms, with the release of cellular components, such as endotoxins, characterizing a focus of contamination (Rioufol et al 1999;Dasgupta 2002;Cappelli et al 2003;Tapia and Yee 2006).…”

Section: Discussionmentioning

confidence: 99%

Microbiological quality of water and dialysate in a haemodialysis unit in Ponta Grossa-PR, Brazil

Borges

Lascowski

Filho

et al. 2007

Journal of Applied Microbiology

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Aims: The objective of the study was to determine the microbiological quality of samples of water and dialysate in a haemodialysis unit. Methods and Results: Seventy‐two samples each of water and dialysate were collected during November 2003 to April 2004. The following microbiological analyses were performed: test for total and faecal coliforms, which produced negative results for all the samples; counts of total heterotrophic bacteria, where three samples of water and two of dialysate showed levels higher than those permitted by national standards; and endotoxin assay, which revealed high quantities only in samples of water that preceded reverse osmosis. Nonfermenting Gram‐negative bacteria were identified in 54 samples of dialysate and in 26 samples of water. The test for adhesion to an inert surface showed that various bacteria were capable of forming biofilms. Twenty‐seven per cent of the bacteria were resistant to sodium hypochlorite at 500 ppm for 10‐min contact time. Sixty per cent of the isolates were resistant to three or more antibiotics. Conclusions: Water and dialysate can be a source of infection for patients who need haemodialysis. Significance and Impact of the Study: An adequate system for water treatment, disinfection of the haemodialysis system and microbiological monitoring of the water and dialysate are necessary to reduce bacteraemia and pyrogenia outbreaks.

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“…Environmental biofilm-forming bacteria or micro-organisms present in cleaning solutions could have entered the water system through this opening. Tubing connections are known to be critical segments of the system and biofilm formation is recognized as a risk for haemodialysis patients (Man et al, 1998;Dasgupta, 2002).…”

Section: Discussionmentioning

confidence: 99%

Characterizing uncommon Burkholderia cepacia complex isolates from an outbreak in a haemodialysis unit

Souza

Moreira

Pasternak

et al. 2004

Journal of Medical Microbiology

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An outbreak of bacteraemia in a haemodialysis unit where 65 episodes of infection involved 35 outpatients is reported. Burkholderia cepacia complex was the agent most frequently recovered from blood. Thirty-three environmental and clinical isolates of B. cepacia complex were characterized by whole-cell protein electrophoresis and recA-RFLP profile. Fourteen isolates were genomovar I and 16 isolates were not classifiable by their recA-RFLP pattern. Ribotyping, random amplification of polymorphic DNA (RAPD) and integron profile were used to explore the clonality of the isolates, and revealed multiple strain genotypes. Four ribotypes and RAPD types and three integron patterns were identified. The water supply was identified as the source of the outbreak, and inappropriate cleaning and a leak in the reverse osmosis tubing connection were the probable causes of contamination. B. cepacia complex was still recovered from blood of patients even after apparently adequate measures were taken and water quality standards were met, suggesting that higher standards for water quality should be adopted in haemodialysis units. The genomovars recovered here were distinct from those commonly reported for cystic fibrosis isolates.

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Biofilms and Infection in Dialysis Patients

Cited by 87 publications

References 78 publications

Peritoneal Dialysis–Related Peritonitis due to Coagulase-Negative Staphylococcus

Peritoneal Dialysis–Related Peritonitis due to Coagulase-Negative Staphylococcus

Microbiological quality of water and dialysate in a haemodialysis unit in Ponta Grossa-PR, Brazil

Characterizing uncommon Burkholderia cepacia complex isolates from an outbreak in a haemodialysis unit

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