Central venous catheters and biofilms: where do we stand in 2017?

Abstract

The use of central venous catheters (CVC) is associated with a risk of microbial colonization and subsequent potentially severe infection. Microbial contamination of the catheter leads to the development of a microbial consortia associated with the CVC surface and embedded in an extracellular matrix, named biofilm. This biofilm provides bacterial cells the ability to survive antimicrobial agents and the host immune system and to disseminate to other sites of the body. The best preventive strategy is to avoid any unnecessary catheterization or to reduce indwelling duration when a CVC is required. Beside aseptic care and antibiotic-impregnated catheters (like minocycline/rifampin), preventive locks can be proposed in some cases, whereas non-biocidal approaches are under active research like anti-adhesive or competitive interactions strategies. When the diagnosis of catheter-related bloodstream infection (CRBSI) is suspected on clinical symptoms, it requires a microbiological confirmation by paired blood cultures in order to avoid unnecessary catheter removal. The treatment of CRBSI relies on catheter removal and systemic antimicrobials. However, antibiotic lock technique (ALT) can be used as an attempt to eradicate biofilm formed on the inside lumen of the catheter in case of uncomplicated long-term catheter-related BSI caused by coagulase-negative staphylococci (CoNS) or Enterobacteriaceae. Recently, promising strategies have been developed to improve biofilm eradication; they rely on matrix degradation or destabilization or the development of anti-persister compounds, targeting the most tolerant bacterial cells inside the biofilm. Understanding biofilm formation at the molecular level may help us to develop new approaches to prevent or treat these frequent infections.

Colonization of medical devices by staphylococci

“…As a result of their high frequency, increased resistance to antibiotic treatment (Weiner et al, 2016), and the frequent necessity to remove the medical device to cure the infection, device-associated infections represent a severe burden to the public health system. For example, infected central venous catheters (CVCs) alone cause about 80 000 cases of bloodstream infections in the United States annually (Gominet et al, 2017). In developing countries, the incidence of deviceassociated nosocomial infections is even higher (Rosenthal et al, 2016).…”

In vitro efficacies and durabilities of antibiotic/vitamin C coated hemodialysis catheters

“…Recently, promising strategies have been developed to improve biofilm eradication (matrix degradation or destabilization or the development of anti-persister compounds, targeting the most tolerant bacterial cells inside the biofilm) that may help to develop novel methodologies to prevent or treat these frequent infections (Gominet et al, 2017).…”

Biotimer assay: A reliable and rapid method for the evaluation of central venous catheter microbial colonization

“…Central venous catheters (CVCs) are a mainstay for management of critically ill patients. However, CVCs may be colonized on intra-and extra-luminal surfaces by microorganisms in adherent and biofilm lifestyle (Dobbins et al, 2003;Gominet et al, 2017). CVC colonization is correlated to infectious episodes and, in particular, the catheter-related bloodstream infections (CRBSIs) are characterized by high rates of morbidity and mortality (Pratt et al, 2001;Chopra et al, 2013;Gahlot et al, 2014;Yousif et al, 2015).…”

“…Unfortunately, no one of these methods is fully reliable. Indeed, the rollplate technique does not determine the intra-luminal colonization of CVCs (Dobbins et al, 2003;Mermel et al, 2009;Guembe et al, 2016;Gominet et al, 2017) and the vortex or sonication methods do not ensure the detachment of all microbes (Pantanella et al, 2013;Freitas et al, 2014). It is evident that a rapid and reliable microbiological method for the early determination of CVC colonization is extremely important.…”