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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (1): 161-165. doi: 10.19723/j.issn.1671-167X.2025.01.024

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Bacterial biofilm formation of peritoneal dialysis catheter in patients with peritonitis-associated catheter removal

Aichun LIU1, Huiping ZHAO1,*(), Bei WU1, Shuying ZHENG2, Li ZUO1, Mei WANG   

  1. 1. Department of Nephrology, Peking University People's Hospital, Beijing 100044, China
    2. Department of Laboratory of Electron Microscope, Peking University People's Hospital, Beijing 100044, China
  • Received:2024-03-28 Online:2025-02-18 Published:2025-01-25
  • Contact: Huiping ZHAO E-mail:huipingzhao2009@163.com

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Abstract:

Objective: Peritoneal dialysis(PD)-associated peritonitis is a common and major complication of PD and the most common cause of technical failure of PD. The presence of bacterial biofilm may be an important factor leading to refractory or recurrence of peritonitis. To investigate the formation and characteristics of bacterial biofilms on PD catheters after peritonitis-associated catheter removal. Methods: The patients with maintenance PD who were regularly followed up in the Peking University People' s Hospital from June 2007 to January 2022 were retrospectively analyzed. The patients who withdrew from PD because of peritonitis and removed the PD catheter in our hospital and underwent the scanning electron microscope examination of the catheter were selected. The general information of the patients, the electron microscope results of the PD catheter and the bacterial culture results of the PD fluid were summarized. Results: (1) A total of 18 patients were included, 11 were female (accounting for 61.1%). The average age of the patients was (59.1±11.5) years, and the average duration of dialysis was (80.1±47.4) months. Primary kidney diseases were predominantly chronic glomerulonephritis (55.6%), followed by diabetic nephropathy (27.8%), and others (16.6%). The reasons for catheters removal in 18 patients were refractory peritonitis in 11 cases, recurrent peritonitis in 5 cases, and fungal peritonitis in 2 cases. (2) 16 of the 18 patients (88.9%) had catheter bacterial biofilm, and the bacterial biofilm forms were all cocci. Some were arranged in grape-like shapes, and their diameters ranged from about 500 nm to 1 000 nm. The bacterial culture results of peritoneal dialysis fluid showed that the three most common pathogens were Escherichia coli, methicillin-sensitive Staphylococcus aureus (MSSA), and Staphylococcus epidermidis. (3) Among the 18 patients enrolled, 13 patients (72.2%) had peritonitis in the past. The causative bacteria of peritonitis in 9 patients were cocci, including coagulase-negative Staphylococci (Staphylococcus suis, Staphylococcus surface, Staphylococcus xylosus, Staphylococcus warneri), Staphylococcus aureus, Streptococcus (Streptococcus salivarius and Aerococus viridans). Conclusion: Bacterial biofilm formation on the inner surface of PD catheter is common in peritonitis-associated catheter removal patients. Not all PD catheters removed due to peritonitis have bacterial biofilms. Bacterial biofilms and peritonitis pathogens may not be consistent.

Key words: Peritoneal dialysis, Catheter-related infections, Bacterial biofilms, Peritonitis

CLC Number: 

  • R459.5

Table 1

Epidemiological and catheter biofilm formation in patients withdrew from PD because of peritonitis"

Items Data (n=18)
Mean age/years, ${\bar x}$±s 58.6±11.7
Male/Female 7/11
Primary diseases of ESRD  
    CGN 10
    DN 5
    Others 3
Duration for PD/months, ${\bar x}$±s 80.1±47.4
Suffered peritonitis in the past  
    Yes 13
    No 5
PD catheter bacterial biofilm formation, n(%)  
    Yes 16 (88.9)
    No 2 (11.1)

Table 2

Biofilms features observed by SEM and results of microbiological culture in peritonitis-related catheter removal group (n=18)"

No. Age/years Gender Primary disease of ESRD Dialysis duration/months Causes for PD catheter removal Results of microbiological cultures Biofilm morphology Outcome History of peritonitis, n Pathogens of PDRP prior to catheter removal
PD fluid PD catheter
1 83 F DN 26 Relapsing peritonitis E. coli ND Coccus, 500 nm Transfer to HD 0 -
2 40 F CGN 68 Refractory peritonitis E. coli ND Coccus, 500 nm Transfer to HD 1 Culture negative
3 62 F CGN 35 Refractory peritonitis E. coli - Coccus, 500nm Transfer to HD 0 -
4 75 F CGN 128 Refractory peritonitis E. coli - Coccus Transfer to HD 3 E. cloacae, S. hominis, Gordonia
5 49 M CGN 70 Refractory peritonitis E. coli - Coccus, 500-700 nm Transfer to HD 0 -
6 61 F CGN 132 Relapsing peritonitis S. epidermidis ND Coccus Transfer to HD 4 Culture negative×2, E. cloacae, S. aureus
7 35 M DN 6 Relapsing peritonitis S. epidermidis ND Coccus Transfer to HD 1 S. epidermidis
8 56 M DN 62 Refractory peritonitis MSSA - Coccus, 1 000 nm Transfer to HD 1 E. coli
9 55 M CGN 95 Refractory peritonitis MSSA - - Transfer to HD 1 Klebsiella pneumoniae
10 70 M DN 4 Relapsing peritonitis MSSA - Coccus Replacement PD catheter and go on PD treatment 2 S. aureus×2
11 54 F DN 102 Refractory peritonitis E. faecalis - - Transfer to HD 1 S. aureus
12 55 F CGN 158 Refractory peritonitis Streptococcus oralis ND Coccus, 1 000 nm Transfer to HD 2 S. salivarius, Brucella
13 52 F CGN 109 Refractory peritonitis Gram-negtive bacilli - Coccus, 1 000 nm Transfer to HD 1 S. xylosus
14 65 F CGN 97 Refractory peritonitis Corynebacterium - Coccus, 500 nm Transfer to HD 0 -
15 57 F AASV 30 Fungal peritonitis T. mucoides ND Coccus, 500 nm Transfer to HD 1 Aerococcus viridans
16 63 F HTN 58 Fungal peritonitis G. candida, S. epidermidis G. candida Coccus, 600-700 nm Transfer to HD 0 -
17 66 M CGN 148 Relapsing peritonitis Rothia - Coccus, 1 000-2 000 nm Transfer to HD 4 Rothia aeria
18 66 M CIN 114 Refractory peritonitis Klebsiella - Coccus, 400 nm Transfer to HD 2 S. warneri, S. epidermidis

Figure 1

Typical case: A 35-year-old man with diabetic nephropathy as the underlying renal condition experienced a recurrence of peritonitis due to Staphylococcus epidermidis, leading to the decision to remove the peritoneal dialysis catheter A, scanning electron microscope (SEM) image showing biofilm formation inner side of the PD catheter lumen, arranged like grape clusters (×4 000); B, SEM image of grape-like biofilm inner side of the PD catheter (×6 000)."

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