Bacteria on Catheters in Patients Undergoing Peritoneal Dialysis

Abstract

♦ Background: Peritonitis is the leading cause of morbidity for peritoneal dialysis (PD) patients, and microbial biofilms have previously been identified on catheters from infected patients. However, few studies of catheters from patients without clinical signs of infection have been undertaken. The aim of the present study was to investigate the extent to which bacteria are present on catheters from PD patients with no symptoms of infection. ♦ Methods: Microbiologic culturing under aerobic and anaerobic conditions and confocal laser scanning microscopy were used to determine the distribution of bacteria on PD catheters from 15 patients without clinical signs of infection and on catheters from 2 infected patients. The 16S rRNA gene sequencing technique was used to identify cultured bacteria. ♦ Results: Bacteria were detected on 12 of the 15 catheters from patients without signs of infection and on the 2 catheters from infected patients. Single-species and mixed-microbial communities containing up to 5 species were present on both the inside and the outside along the whole length of the colonized catheters. The bacterial species most commonly found were the skin commensals Staphylococcus epidermidis and Propionibacterium acnes, followed by S. warneri and S. lugdunensis. The strains of these micro-organisms, particularly those of S. epidermidis, varied in phenotype with respect to their tolerance of the major classes of antibiotics. ♦ Conclusions: Bacteria were common on catheters from patients without symptoms of infection. Up to 4 different bacterial species were found in close association and may represent a risk factor for the future development of peritonitis in patients hosting such micro-organisms.

Update on the challenging role of biofilms in peritoneal dialysis

“…Biofilms have been found on the intra-and extraluminal surfaces of the catheter (Dasgupta et al 1987;Gorman et al 1994; Guerra e Silva et al 2011;Pihl et al 2013) with an uneven distribution, presenting areas with different degrees of colonization along the catheter (Marrie et al 1983;Dasgupta et al 1987). A tendency to accumulate at the catheter pores was reported (Gorman et al 1994), which may in part be explained by the hydrodynamic and shear forces inherent to the PD exchanges.…”

“…Accordingly, staphylococci were commonly observed associated with catheters explanted from patients without infection (Table 2). Although in the population of patients without infection, a major occurrence of negative cultures was observed, the percentage within each study ranged from 16% (Dasgupta et al 1987) to 100% (Verger et al 1987), being 40% in the most recent study (Pihl et al 2013). However, it should be remarked that negative cultures were also observed on catheters explanted from patients with peritonitis (Dasgupta et al 1986(Dasgupta et al , 1987.…”

“…Studies performed with several microorganisms suggest that cells within biofilms may be tolerant to phagocytosis, phagocytic killing, and antibodies (Arciola et al 2012). Accordingly, the inability of the host immune system to clear P. aeruginosa biofilm infections in the peritoneal cavity has been shown, even in pre-immu- (Dasgupta et al 1986(Dasgupta et al , 1987Bayston et al 1999) a 2/16 (Dasgupta et al 1986) 14/72 (Marrie et al 1983;Dasgupta et al 1986Dasgupta et al , 1987 a (Bayston et al 1999) b (Pihl et al 2013) a, c, d…”

“…1/18 (Bayston et al 1999) 1/32 (Bayston et al 1999) -1/72 (Pihl et al 2013) Micrococcus spp. Rothia mucilaginosa ---1/72 (Pihl et al 2013) Staphylococcus aureus 10/18 (Marrie et al 1983;Dasgupta et al 1986;Bayston et al 1999) 5/32 (Dasgupta et al 1987;Bayston et al 1999) 10/16 (Marrie et al 1983;Dasgupta et al 1986;Bayston et al 1999;Pihl et al 2013) 2/72 (Dasgupta et al 1987) Streptococcus spp.…”

Acute Peritonitis Caused by Propionibacterium Acnes in a Peritoneal Dialysis Patient

“…It has also been identified as a cause of several orthopedic, silicone breast prosthesis, and prosthetic joint infections [8][9][10]. It has also been found on peritoneal catheters from patients without signs of infection [11]. The tendency of P. acnes to form biofilm [8] suggests potential benefit of intraperitoneal application as well as for prolonged antibiotic treatment to avoid recurrent infection.…”