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2012 ; 1
(1
): 50-54
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Morphological analysis of biofilm of peritoneal dialysis catheter in refractory
peritonitis patient
#MMPMID28509153
Kusaba T
; Kirita Y
; Ishida R
; Matsuoka E
; Nakayama M
; Uchiyama H
; Kajita Y
CEN Case Rep
2012[May]; 1
(1
): 50-54
PMID28509153
show ga
A 66-year-old man undergoing peritoneal dialysis (PD) was admitted to our
hospital for treatment of PD-related peritonitis. Culture of the PD fluid
revealed the presence of Citrobacter freundii, and therapy with ceftazidime was
started intraperitoneally. The cell count in PD fluid slowly decreased over time
during the first 2 weeks of treatment, but increased again on the 14th hospital
day. A second culture of the PD fluid revealed the presence of Enterococcus
species. A switch in antibiotic therapy to vancomycin did not improve the cell
count in the PD fluid. A third culture of the PD fluid revealed the presence of
Stenotrophomonas maltophilia. The PD was discontinued and the catheter removed on
the 28th hospital day. Examination of the catheter revealed that the inner tip
was coated with a fibrous sheet of cells, suggesting biofilm formation. Following
catheter removal, the patient was administered intravenous ciprofloxacin, and the
inflammatory reaction started to disappear immediately and had completely
disappeared after 1 week of treatment. Microscopic analysis of the fibrous
structure on the catheter revealed multiple layers of various inflammatory cells.
Immunostaining revealed the presence of CD44-positive polynuclear cells,
indicating neutrophils, facing the catheter lumen. CD68-positive cells,
indicating macrophages, were observed in the following layer, and
keratin-positive cells, indicating peritoneal mesothelial cells, were present at
the bottom of the structure. Based on the immediate improvement of PD-related
peritonitis after catheter removal, we presumed that this biofilm contributed to
the intractability of the patient's peritonitis. Morphological analysis of
catheter revealed that both the mesothelial cells and the various inflammatory
cells may have contributed to biofilm development.