Characteristics of Biofilm on Tunneled Cuffed Hemodialysis Catheters in the Presence and Absence of Clinical Infection

Ramanathan, Venkataraman; Riosa, Sarah; AlSharif, Atef; Mansouri, Mohammad D.; Tranchina, Andrew; Kayyal, T.; Abreo, Andrew; Aslam, Saima; Nassar, George M.; Darouiche, Rabih O.

doi:10.1053/j.ajkd.2012.06.003

Cited by 25 publications

(21 citation statements)

References 22 publications

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“…Recently, it has been shown that haemodialysis patients suffering from CRBSI had thicker biofilms on all catheter surfaces compared with (clinically) nonbacteremic patients. In the latter group, in catheters removed for noninfectious reasons, catheter cultures were positive in 30% (extra‐ and intravascular segments combined) . In our study, we had two haemodialysis patients with positive screening tests without subsequent signs and symptoms of bacteremia; routine DTP test therefore was not ordered, and the patients were considered not to have CRBSI.…”

Section: Discussionmentioning

confidence: 96%

Microbiological screening for earlier detection of central venous catheter–related bloodstream infections

Wagner

Schilcher

Zollner‐Schwetz

et al. 2013

Eur J Clin Investigation

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Section: Discussionmentioning

confidence: 96%

Microbiological screening for earlier detection of central venous catheter–related bloodstream infections

Wagner

Schilcher

Zollner‐Schwetz

et al. 2013

Eur J Clin Investigation

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“…It also has to be considered that in this model, electrodes were placed intraluminally, not affecting the outer catheter surface. In vivo biofilms may grow on the outer and inner surfaces of infected catheters (41,42). Interestingly, studies using electrified catheters with comparable electrode positioning showed reduced encrustation by Proteus mirabilis biofilms at the catheter eyelet region in vitro (43) and reduced microbial populations associated with catheter-associated urinary tract infections in vivo (44,45).…”

Section: Discussionmentioning

confidence: 99%

Antibiofilm Activity of Electrical Current in a Catheter Model

Voegele

Badiola

Schmidt-Malan

et al. 2016

Antimicrob Agents Chemother

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Catheter-associated infections are difficult to treat with available antimicrobial agents because of their biofilm etiology. We examined the effect of low-amperage direct electrical current (DC) exposure on established bacterial and fungal biofilms in a novel experimental in vitro catheter model. Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Candida parapsilosis biofilms were grown on the inside surfaces of polyvinyl chloride (PVC) catheters, after which 0, 100, 200, or 500 A of DC was delivered via intraluminally placed platinum electrodes. Catheter biofilms and intraluminal fluid were quantitatively cultured after 24 h and 4 days of DC exposure. Time-and dose-dependent biofilm killing was observed with all amperages and durations of DC administration. Twenty-four hours of 500 A of DC sterilized the intraluminal fluid for all bacterial species studied; no viable bacteria were detected after treatment of S. epidermidis and S. aureus biofilms with 500 A of DC for 4 days. Catheter-associated infections, including catheter-associated urinary tract infection (CAUTI) and catheter-related bloodstream infection (CRBSI), are associated with morbidity, mortality, and expense, often requiring catheter removal. The pathogenesis of these infections relates to the presence of biofilms on the surface of the catheters.Compared with planktonic (i.e., free-floating) forms, microorganisms in biofilms exhibit increased resistance to host immunity and antimicrobial therapy (1). Proposed mechanisms underlying biofilm-associated antimicrobial resistance include limited penetration through or neutralization of antimicrobials within biofilms (2, 3); subpopulations of resistant phenotypes, referred to as "persister" cells (4, 5); and dormant stationary-phase zones within biofilms (4, 6, 7). As a result, most conventional systemically administered antimicrobial agents have little ability to cure catheter-associated infections. Catheter removal is necessary in the majority of cases, typically in conjunction with systemic antimicrobial treatment. Strategies to control biofilms, such as coating catheters with silver ions, chlorhexidine or minocycline plus rifampin, have been proposed (8-12), and catheter lock solutions, using conventional antimicrobial agents or antiseptics, have shown activity against catheter-associated biofilms (13-19). However, none of these strategies has solved the clinical challenge of catheter-associated infections, underscoring the need for new approaches.We previously described an antibiofilm strategy that we termed the electricidal effect. Biofilms of Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa on Teflon discs were exposed to 20, 200, or 2,000 A direct current (DC) for up to 7 days, which resulted in time-and dose-dependent antibiofilm effects, as measured by decreases in numbers of viable cells (20). Subsequent studies confirmed the microbicidal activity of continuously and intermittently applied electrical current against estab...

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“…The formation of biofilm plays a major role in the pathophysiology and treatment of CLABSIs. In patients with bacteremia, the outer surface of the extravascular segment of the tunneled dialysis catheters has the thickest measured biofilm and is most likely to have an organism cultured [34] . The presence and location of the biofilm contributes to the need for catheter removal in certain infections.…”

Section: Management Of Bsismentioning

confidence: 99%

Nosocomial Infections in Dialysis Access

Schweiger

Trevino²,

Marschall³

2015

Contributions to Nephrology

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Nosocomial infections in patients requiring renal replacement therapy have a high impact on morbidity and mortality. The most dangerous complication is bloodstream infection (BSI) associated with the vascular access, with a low BSI risk in arteriovenous fistulas or grafts and a comparatively high risk in central venous catheters. The single most important measure for preventing BSI is therefore the reduction of catheter use by means of early fistula formation. As this is not always feasible, prevention should focus on educational efforts, hand hygiene, surveillance of dialysis-associated events, and specific measures at and after the insertion of catheters. Core measures at the time of insertion include choosing the optimal site of insertion, the use of maximum sterile barrier precautions, adequate skin antisepsis, and the choice of catheter type; after insertion, access care needs to ensure hub disinfection and regular dressing changes. The application of antimicrobial locks is reserved for special situations. Evidence suggests that bundling a selection of the aforementioned measures can significantly reduce infection rates. The diagnosis of central lineassociated BSI (CLABSI) is based on clinical signs and microbiological findings in blood cultures ideally drawn both peripherally and from the catheter. The prompt installation of empiric antibiotic treatment covering the most commonly encountered organisms is key regarding CLABSI treatment. Catheter removal is recommended in complicated cases or if cultures yield Staphylococcus aureus , enterococci, Pseudomonas or fungi. In other cases, guide wire exchange or catheter salvage strategies with antibiotic lock solutions may be acceptable alternatives.

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Characteristics of Biofilm on Tunneled Cuffed Hemodialysis Catheters in the Presence and Absence of Clinical Infection

Cited by 25 publications

References 22 publications

Microbiological screening for earlier detection of central venous catheter–related bloodstream infections

Microbiological screening for earlier detection of central venous catheter–related bloodstream infections

Antibiofilm Activity of Electrical Current in a Catheter Model

Nosocomial Infections in Dialysis Access

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