BACTERIAL BIOFILMS AND PERITONITIS IN CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS

Colonization of peritoneal catheters by biofilm bacteria is common in patients undergoing treatment with continuous ambulatory peritoneal dialysis (CAPD) for end stage renal disease. The biofilm matrix generated by the colonized bacteria involves changes of the surface composition by interreaction with host tissue proteins and phagocytic cells. The biofilm therefore represents a state of biodegradation of colonized bacteria, host proteins, cells, dialysis solutions and plastic catheters. Stable biofilm, thus formed. protects the colonized bacteria from the killing effects of antibiotics, antibodies and other host defense molecules. It is postulated that catheter biofilms constitute a bacterial reservoir in patients undergoing CAPD treatment and may produce clinical peritonitis. A method to isolate biofilm bacteria from peritoneal dialysis effluents with the use of a modified Robbins' Device is described. Preliminary results indicate that use of this technique can be useful in the identification of a subgroup of CAPD patients at risk of developing antibiotic resistant stable biofilms with recurrent peritonitis and loss of peritoneal catheters.