Significance of Biofilm-Adherent Bacterial Microcolonies on Tenckhoff Catheters of CAPD Patients

Dasgupta, Mrinal; Costerton, J. W.

doi:10.1159/000169586

Cited by 39 publications

(28 citation statements)

References 13 publications

(33 reference statements)

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“…9,17 The catheter was cultured with the fluid in each rat at the end of the injection period, and only culture-negative rats were used in the reported studies. Although the 48-h culture should have produced bacterial colonies if planktonic bacterium was present, most biofilms require electron microscopy or specialized confocal microscopy for their study.…”

Section: Basic Research Wwwjasnorgmentioning

confidence: 99%

Peritoneal Changes after Exposure to Sterile Solutions by Catheter

Flessner

Credit²,

Henderson³

et al. 2007

Journal of the American Society of Nephrology

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Most current animal models that are used to study effects of long-term peritoneal exposure to dialysis solutions use an indwelling catheter for daily injections. It was hypothesized that the presence of a foreign body in the peritoneal cavity (PC) might alter the inflammatory response to the solutions and that the response would depend on exposure duration. For addressing these, long-term injections were carried out for 2 to 8 wk in 90 Sprague-Dawley rats: 40 via a subcutaneous port connected to a silicone catheter tunneled to the PC, 40 via direct needle injection, and 10 noninjected, age-control rats. Daily volumes were 30 to 40 ml of filter-sterilized, bicarbonate-buffered solutions that contained 4% dextrose. After 2, 4, 6, and 8 wk, anesthetized rats underwent transport experiments with a chamber affixed to the abdominal wall to determine mass transfer coefficients of mannitol (MTC mannitol ) and albumin (MTC BSA ), osmotic filtration flux (J osm ), and hydrostatic pressure-driven flux. After the rats were killed, tissues were collected for measurement of peritoneal thickness, vascular density, and immunohistochemical staining. ANOVA demonstrated significant (P Ͻ 0.01) differences in thickness, vessel density, MTC mannitol , and MTC BSA among the groups at the various time intervals and in overall means. Differences among the groups were less pronounced for hydrostatic pressure-driven flux and J osm . Vessel density, MTC mannitol , MTC BSA , and J osm were dependent on injection duration (P Ͻ 0.01). There were marked differences between the needle injection and catheter injection groups at various intervals in the expression of three cytokines. It is concluded that the histologic and functional response depends on the duration of injection with animals that are exposed for as little as 2 wk demonstrating alterations. These findings confirm the hypothesis that the presence of a PC catheter increases inflammatory response to sterile solutions as evidenced by the structural and functional changes in the peritoneal barrier. 18: 229418: -230218: , 200718: . doi: 10.1681 Exposure of the peritoneum to sterile solutions that contain glucose results in changes in cellular characteristics, histology, and barrier function. Long-term peritoneal dialysis (PD) without evidence of peritonitis alters the phenotypic appearance of the human peritoneum in 8 to 12 mo. 1 Biopsy studies of longterm (Ͼ3 yr) PD patients have demonstrated marked thickening over time of the subcompact zone, a region between the mesothelial cells and their basement membrane, with corresponding changes in the underlying microvasculature. 2 Exposure of patients to glucose-based dialysis solutions resulted in significant functional changes in transperitoneal transport in a 2-yr study of patients who were treated with automated PD. 3 Studies in animal models parallel these changes and have demonstrated benefit of solutions that are thought to be more biocompatible. 4 -6 Studies in our laboratory using an animal model with a subcutaneous inj...

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Section: Basic Research Wwwjasnorgmentioning

confidence: 99%

Peritoneal Changes after Exposure to Sterile Solutions by Catheter

Flessner

Credit²,

Henderson³

et al. 2007

Journal of the American Society of Nephrology

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“…Several predisposing factors are required for development of biofilm infections in human: a source of bacterial contamination of a sterile human body compartment by the medical device or a catheter, a foreign surface for bacterial adherence (e.g., human tissue and/or a catheter or medical device), and a fluid environment where bacteria can grow and draw constant nutrition for formation of adherent biofilm‐encased microcolonies on the foreign surfaces. In patients undergoing HD and PD treatment these conditions are easily met: use of catheters (peritoneal and venous) and arteriovenous (AV) grafts allow unintentional entry of skin bacteria into sterile body compartments; dialysis catheters and grafts provide the foreign surface required for bacterial attachment; and the PD effluent fluid, blood, and dialysis fluid in the fluid pathways of the HD circuit provide the necessary environment and nutritional support for the growth of biofilm microcolonies (2,4–6) (Fig. 2).…”

Section: Biology Of Biofilm Formation and Clinical Infectionsmentioning

confidence: 99%

“…Biofilm formation on peritoneal catheters is common (2). Primary factors that regulate biofilm formation in PD are skin bacteria which colonize PD catheters, catheter biomaterials which allow bacteria to adhere, and a PD environment which provides optimum conditions for growth and proliferation of biofilm bacterial microcolonies.…”

Section: Biofilms In Peritoneal Dialysismentioning

confidence: 99%

Biofilms and Infection in Dialysis Patients

Dasgupta

2002

Seminars in Dialysis

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Biofilm bacterial infections are implicated in most human bacterial infections and are also common in patients undergoing treatment with hemodialysis and peritoneal dialysis. Skin bacteria, which grow into microcolonies with biofilm formation in dialysis environments, are implicated in most of these infections. Dissemination of bacterial biofilms in hemodialysis patients induces bacteremia and endotoxemia. In peritoneal dialysis patients, biofilm causes peritonitis and catheter-related infections with consequent loss of catheters and technique failure. Effective strategies for the diagnosis, intervention, and prevention of biofilm-related infections in dialysis patients are described in this review.

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“…In fact, BB colonization of the TC via both routes may occur in all patients undergoing CAPD [3,4]. We speculate that these adherent BB populations serve as protected bacterial reservoirs, and that the dissemina tion of bacteria from the protected biofilms leads to peri tonitis when host defence factors fail to contain them [12]. S. epidermidis is not only the bacterium most com monly responsible for episodes of peritonitis in CAPD; it is also the predominant organism in touch contamina tion during clinical dialysis exchange [2], and it adopts a demonstrable biofilm mode of growth on TC materials [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…This first requires the clini cal confirmation of earlier findings [5] by studies of effluents from patients with the TC in situ. Meanwhile, much needs to be learned about the use of various types of biological materials, such as bleach, new antibiotics, and biofilm-resistant catheter materials that will resist the formation of BB and thus prevent or eliminate CAPD-associated peritonitis [12], which appears to be the predominant cause of dropout from this alternative mode of maintenance dialysis treatment [1], …”

Section: Discussionmentioning

confidence: 99%

Growth of Bacterial Biofilms on Tenckhoff Catheter Discs in vitro after Simulated Touch Contamination of the Y-Connecting Set in Continuous Ambulatory Peritoneal Dialysis

Dasgupta

Larabie²,

Lam³

et al. 1990

Am J Nephrol

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We simulated touch contamination of peritoneal dialysis fluids perfused through an in vitro system with a modified Robbins’ device (MRD) and Y-connecting tubings, to study the pathogenesis of bacterial biofilm (BB) growth on Tenckhoff catheter (TC) discs. The spike ends of Y-connecting sets were dipped in a suspension of freshly cultured cells of Staphylococcus epidermidis (3X10⁸ cfu/ml), and connected to 2 litres of 0.5 % dianeal solution which was perfused through the MRD with plugs containing TC discs. Four simulated clinical exchanges were performed with or without prior flushing and/or bleach treatment of the Y sets. Control experiments were done with fresh Dianeal solution with no contamination, flushing, or bleach treatment. BB growth on the TC discs was examined by scanning electron microscopy (SEM) and transmission electron microscopy and quantitated by routine culture of scrapings from the discs. We noted that touch contamination of dialysis fluids via the spike ends of the connecting sets can generate dense BB growth on TC discs in this experimental system (62 ± 8% by SEM and 10.2 ± 8.3 X 10³ cfu/ml by culture). This growth of BB was significantly reduced by flushing the Y set with sterile Dianeal solution (24.3 ± 3% by SEM and 5.7 ± 3.5 X 10¹ cfu/ml by culture) and was absent by bleach treatment. We conclude that although bleach treatment of Y sets can prevent BB growth, the ‘flushing’ procedure alone can significantly reduce BB growth on TC from touch contamination of dialysate fluid.

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Significance of Biofilm-Adherent Bacterial Microcolonies on Tenckhoff Catheters of CAPD Patients

Cited by 39 publications

References 13 publications

Peritoneal Changes after Exposure to Sterile Solutions by Catheter

Peritoneal Changes after Exposure to Sterile Solutions by Catheter

Biofilms and Infection in Dialysis Patients

Growth of Bacterial Biofilms on Tenckhoff Catheter Discs in vitro after Simulated Touch Contamination of the Y-Connecting Set in Continuous Ambulatory Peritoneal Dialysis

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