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Bouery C, Azeroual L, Hufnagel G, Vrtovsnik F, Goffin É. [Peritoneal dialysis catheter sterilization by urokinase administration in case of relapsing peritonitis: About four observations]. Nephrol Ther 2021; 17:128-131. [PMID: 33431312 DOI: 10.1016/j.nephro.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/02/2020] [Accepted: 09/16/2020] [Indexed: 10/22/2022]
Abstract
The presence of a biofilm within the peritoneal dialysis catheter where bacteria are encapsulated, protected from the action of antibiotics and insidiously liberated within the dialysate, best explains the relapse of the infectious peritonitis, when antibiotics are withdrawn. We here report a serie of four clinical cases in whom the administration of urokinase within the peritoneal catheter in addition to the current antibiotherapy, has cured relapsing peritonitis due to Staphylococcus epidermidis in two cases, Acinetobacterjohnsonii in one case and Staphylococcus haemolyticus in one case, respectively. This approach, safe and easy, allowed the infection eradication and did prevent a catheter removal and a potential transfer of the patients to hemodialysis.
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Affiliation(s)
- Céline Bouery
- Département de néphrologie, CHU Bichat-Claude Bernard, 75000 Paris, France; Département de néphrologie, Hôpital Saint-Georges Ajaltoum, Beyrouth, Liban; Département de néphrologie, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Institut Recherche Expérimentale et Clinique, avenue Hippocrate 10, 1200 Bruxelles, Belgique
| | - Latifa Azeroual
- Département de néphrologie, CHU Bichat-Claude Bernard, 75000 Paris, France
| | - Gilles Hufnagel
- Département de néphrologie, Clinique Ambroise Paré, Neuilly, France
| | - François Vrtovsnik
- Département de néphrologie, CHU Bichat-Claude Bernard, 75000 Paris, France
| | - Éric Goffin
- Département de néphrologie, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Institut Recherche Expérimentale et Clinique, avenue Hippocrate 10, 1200 Bruxelles, Belgique.
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2
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Alvarez Nadal M, Sosa Barrios RH, Burguera Vion V, Campillo Trapero C, Fernández Lucas M, Rivera Gorrín ME. Taurolidine Peritoneal Dialysis Catheter Lock to Treat Relapsing Peritoneal Dialysis Peritonitis. Kidney Med 2020; 2:650-651. [PMID: 33089141 PMCID: PMC7568065 DOI: 10.1016/j.xkme.2020.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Peritonitis remains a primary challenge for the long-term success of peritoneal dialysis (PD) technique and one of the main reasons for catheter removal. Prevention and treatment of catheter-related infections are major concerns to avoid peritonitis. The use of taurolidine catheter-locking solution to avoid the development of a biofilm in the catheter's lumen has obtained good results in hemodialysis catheters for reducing infection rates, although there is scarce literature available regarding its utility in PD. We describe the case of a woman in her 60s who developed relapsing peritonitis due to Pseudomonas aeruginosa, with no possibility of removing peritoneal dialysis catheter because she was not a suitable candidate for hemodialysis. After the fourth peritonitis episode caused by Pseudomonas species, the use of taurolidine catheter-locking solution was initiated. She received a total of 9 doses, with a favorable microbiological and clinical outcome and no further relapses more than 10 months after taurolidine PD catheter lock treatment was started. We report the successful elimination of an aggressive bacteria after taurolidine PD catheter lock use, with no relevant adverse events.
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Affiliation(s)
| | - R Haridian Sosa Barrios
- Servicio de Nefrología. Hospital Universitario Ramón y Cajal, Madrid, Spain.,Grupo de Nefrología Diagnóstica e Intervencionista _(GNDI) de la Sociedad Española de Nefrología, Madrid, Spain
| | - Víctor Burguera Vion
- Servicio de Nefrología. Hospital Universitario Ramón y Cajal, Madrid, Spain.,Grupo de Nefrología Diagnóstica e Intervencionista _(GNDI) de la Sociedad Española de Nefrología, Madrid, Spain
| | | | - Milagros Fernández Lucas
- Servicio de Nefrología. Hospital Universitario Ramón y Cajal, Madrid, Spain.,Grupo de Nefrología Diagnóstica e Intervencionista _(GNDI) de la Sociedad Española de Nefrología, Madrid, Spain.,Universidad de Alcalá, UAH, Madrid, Spain.,Instituto Ramón y Cajal de Investigaciones Sanitarias (IryCis), Madrid, Spain.,Red de Investigación Renal (RedinREn), Madrid, Spain
| | - Maite E Rivera Gorrín
- Servicio de Nefrología. Hospital Universitario Ramón y Cajal, Madrid, Spain.,Grupo de Nefrología Diagnóstica e Intervencionista _(GNDI) de la Sociedad Española de Nefrología, Madrid, Spain.,Universidad de Alcalá, UAH, Madrid, Spain.,Instituto Ramón y Cajal de Investigaciones Sanitarias (IryCis), Madrid, Spain.,Red de Investigación Renal (RedinREn), Madrid, Spain
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3
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Sosa Barrios RH, Álvarez Nadal M, Burguera Vion V, Campillo Trapero C, López Melero E, Fernández Lucas M, Rivera Gorrín ME. Relapsing peritonitis and taurolidine peritoneal catheter lock: One center experience. J Vasc Access 2020; 22:261-265. [PMID: 32605474 DOI: 10.1177/1129729820937099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Relapsing peritonitis due to the development of a biofilm in the catheter's lumen remains an important complication of peritoneal dialysis therapy that endangers technique continuity. Taurolidine catheter lock has proven efficient reducing infection rates in permanent hemodialysis catheters based on its biocidal activity and biofilm detachment effect. Efficacy evidence on its use in peritoneal dialysis catheters is lacking. METHODS We retrospectively analyzed all relapsing peritonitis episodes from June 2018 until October 2019 in our center. Patients were identified and data were collected from our electronic renal registry and patient's records. RESULTS Six patients were identified during the study period. Most patients (66.6%) were on automated peritoneal dialysis and the median duration of peritoneal dialysis before the episode of taurolidine was started was 43.66 ± 29.64 months. Mean taurolidine doses were 10 (range: 9-11) and 83.3% (five patients, with peritonitis caused by Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, and Corynebacterium propinquum) had a favorable response and microbial eradication without relapses after taurolidine treatment. Only one patient relapsed by the same organism (Corynebacterium amycolatum) due to non-adherence to the antibiotic treatment prescribed. None of the patients experienced any relevant adverse events, with only two out of six presenting mild transient abdominal discomfort. CONCLUSION We believe that peritoneal catheter taurolidine lock could be considered in cases of relapsing or refractory peritonitis, as it could prevent catheter removal and permanent switch to hemodialysis in selected cases, although literature is scarce and further studies are needed.
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Affiliation(s)
- R Haridian Sosa Barrios
- Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología, Spain
| | | | - Víctor Burguera Vion
- Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología, Spain
| | | | | | - Milagros Fernández Lucas
- Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología, Spain.,Universidad de Alcalá, UAH, Madrid, Spain.,REDinREN, Madrid, Spain
| | - Maite E Rivera Gorrín
- Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología, Spain.,Universidad de Alcalá, UAH, Madrid, Spain.,REDinREN, Madrid, Spain
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4
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Stadermann MB, Rusthoven E, Van De Kar NC, Hendriksen A, Monnens LAH, Schröder CH. Local Fibrinolytic Therapy with Urokinase for Peritoneal Dialysis Catheter Obstruction in Children. Perit Dial Int 2020. [DOI: 10.1177/089686080202200114] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Marike B. Stadermann
- Pediatric Dialysis Units Wilhelmina Children's Hospital, Utrecht The Netherlands
| | - Esther Rusthoven
- Pediatric Dialysis Units Wilhelmina Children's Hospital, Utrecht The Netherlands
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5
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Bakkaloglu SA, Warady BA. Difficult peritonitis cases in children undergoing chronic peritoneal dialysis: relapsing, repeat, recurrent and zoonotic episodes. Pediatr Nephrol 2015; 30:1397-406. [PMID: 25231680 DOI: 10.1007/s00467-014-2952-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/16/2014] [Accepted: 08/26/2014] [Indexed: 12/22/2022]
Abstract
Despite technological improvements in dialysis connectology and dialysis technique, peritonitis remains the most common and most significant complication of peritoneal dialysis (PD) in children. Most children undergoing chronic PD experience none or only one peritonitis episode, while others have multiple episodes or episodes secondary to unusual organisms. Knowledge of potential risk factors and likely patient outcome is imperative if treatment is to be optimized. In this review we will, in turn, describe episodes of peritonitis that are characterized as either relapsing, recurrent, repeat or zoonosis-related to highlight the clinical issues that are commonly encountered by clinicians treating these infections.
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Affiliation(s)
- Sevcan A Bakkaloglu
- Department of Pediatrics, Division of Pediatric Nephrology, Gazi University School of Medicine, Ankara, Turkey,
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6
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McGuire AL, Bennett SC, Lansley SM, Popowicz ND, Varano della Vergiliana JF, Wong D, Lee YCG, Chakera A. Preclinical assessment of adjunctive tPA and DNase for peritoneal dialysis associated peritonitis. PLoS One 2015; 10:e0119238. [PMID: 25742006 PMCID: PMC4351066 DOI: 10.1371/journal.pone.0119238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 01/11/2015] [Indexed: 12/21/2022] Open
Abstract
A major complication of peritoneal dialysis is the development of peritonitis, which is associated with reduced technique and patient survival. The inflammatory response elicited by infection results in a fibrin and debris-rich environment within the peritoneal cavity, which may reduce the effectiveness of antimicrobial agents and predispose to recurrence or relapse of infection. Strategies to enhance responses to antimicrobial agents therefore have the potential to improve patient outcomes. This study presents pre-clinical data describing the compatibility of tPA and DNase in combination with antimicrobial agents used for the treatment of PD peritonitis. tPA and DNase were stable in standard dialysate solution and in the presence of antimicrobial agents, and were safe when given intraperitoneally in a mouse model with no evidence of local or systemic toxicity. Adjunctive tPA and DNase may have a role in the management of patients presenting with PD peritonitis.
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Affiliation(s)
- Amanda L. McGuire
- Translational Renal Research Group, Harry Perkins Institute of Medical Research, Perth, Australia
- University of Western Australia, School of Medicine and Pharmacology, Perth, Australia
| | - Sophia C. Bennett
- Translational Renal Research Group, Harry Perkins Institute of Medical Research, Perth, Australia
- University of Western Australia, School of Medicine and Pharmacology, Perth, Australia
| | - Sally M. Lansley
- Pleural Disease Unit, Lung Institute of Western Australia, Centre for Asthma, Allergy Respiratory Research, School of Medicine and Pharmacology, Perth, Australia
| | - Natalia D. Popowicz
- Pleural Disease Unit, Lung Institute of Western Australia, Centre for Asthma, Allergy Respiratory Research, School of Medicine and Pharmacology, Perth, Australia
| | - Julius F. Varano della Vergiliana
- Pleural Disease Unit, Lung Institute of Western Australia, Centre for Asthma, Allergy Respiratory Research, School of Medicine and Pharmacology, Perth, Australia
| | - Daniel Wong
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Perth, Australia
| | - Y. C. Gary Lee
- Pleural Disease Unit, Lung Institute of Western Australia, Centre for Asthma, Allergy Respiratory Research, School of Medicine and Pharmacology, Perth, Australia
- Respiratory Department, Sir Charles Gairdner Hospital, Perth, Australia
| | - Aron Chakera
- Translational Renal Research Group, Harry Perkins Institute of Medical Research, Perth, Australia
- University of Western Australia, School of Medicine and Pharmacology, Perth, Australia
- Renal Department, Sir Charles Gairdner Hospital, Perth, Australia
- * E-mail:
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7
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Gurman P, Miranda OR, Nathan A, Washington C, Rosen Y, Elman NM. Recombinant tissue plasminogen activators (rtPA): a review. Clin Pharmacol Ther 2015; 97:274-85. [PMID: 25670034 DOI: 10.1002/cpt.33] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/04/2014] [Indexed: 11/08/2022]
Affiliation(s)
- P Gurman
- Institute for Soldier Nanotechnologies, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA; Department of Materials Science and Bioengineering, University of Texas at Dallas, Richardson, Texas, USA
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8
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Hanke ML, Heim CE, Angle A, Sanderson SD, Kielian T. Targeting macrophage activation for the prevention and treatment of Staphylococcus aureus biofilm infections. THE JOURNAL OF IMMUNOLOGY 2013; 190:2159-68. [PMID: 23365077 DOI: 10.4049/jimmunol.1202348] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Biofilm infections often lead to significant morbidity due to their chronicity and recalcitrance to antibiotics. We have demonstrated that methicillin-resistant Staphylococcus aureus (MRSA) biofilms can evade macrophage (MΦ) antibacterial effector mechanisms by skewing MΦs toward an alternatively activated M2 phenotype. To overcome this immune evasion, we have used two complementary approaches. In the first, a proinflammatory milieu was elicited by local administration of classically activated M1 MΦs and in the second by treatment with the C5a receptor (CD88) agonist EP67, which invokes MΦ proinflammatory activity. Early administration of M1-activated MΦs or EP67 significantly attenuated biofilm formation in a mouse model of MRSA catheter-associated infection. Several proinflammatory mediators were significantly elevated in biofilm-infected tissues from MΦ- and EP67-treated animals, revealing effective reprogramming of the biofilm environment to a proinflammatory milieu. A requirement for MΦ proinflammatory activity was demonstrated by the fact that transfer of MyD88-deficient MΦs had minimal impact on biofilm growth. Likewise, neutrophil administration had no effect on biofilm formation. Treatment of established biofilm infections with M1-activated MΦs also significantly reduced catheter-associated biofilm burdens compared with antibiotic treatment. Collectively, these results demonstrate that targeting MΦ proinflammatory activity can overcome the local immune inhibitory environment created during biofilm infections and represents a novel therapeutic strategy.
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Affiliation(s)
- Mark L Hanke
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
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9
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Warady BA, Bakkaloglu S, Newland J, Cantwell M, Verrina E, Neu A, Chadha V, Yap HK, Schaefer F. Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int 2013; 32 Suppl 2:S32-86. [PMID: 22851742 DOI: 10.3747/pdi.2011.00091] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri 64108, USA.
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10
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Hanke ML, Angle A, Kielian T. MyD88-dependent signaling influences fibrosis and alternative macrophage activation during Staphylococcus aureus biofilm infection. PLoS One 2012; 7:e42476. [PMID: 22879997 PMCID: PMC3411753 DOI: 10.1371/journal.pone.0042476] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 07/09/2012] [Indexed: 02/06/2023] Open
Abstract
Bacterial biofilms represent a significant therapeutic challenge based on their ability to evade host immune and antibiotic-mediated clearance. Recent studies have implicated IL-1β in biofilm containment, whereas Toll-like receptors (TLRs) had no effect. This is intriguing, since both the IL-1 receptor (IL-1R) and most TLRs impinge on MyD88-dependent signaling pathways, yet the role of this key adaptor in modulating the host response to biofilm growth is unknown. Therefore, we examined the course of S. aureus catheter-associated biofilm infection in MyD88 knockout (KO) mice. MyD88 KO animals displayed significantly increased bacterial burdens on catheters and surrounding tissues during early infection, which coincided with enhanced dissemination to the heart and kidney compared to wild type (WT) mice. The expression of several proinflammatory mediators, including IL-6, IFN-γ, and CXCL1 was significantly reduced in MyD88 KO mice, primarily at the later stages of infection. Interestingly, immunofluorescence staining of biofilm-infected tissues revealed increased fibrosis in MyD88 KO mice concomitant with enhanced recruitment of alternatively activated M2 macrophages. Taken in the context of previous studies with IL-1β, TLR2, and TLR9 KO mice, the current report reveals that MyD88 signaling is a major effector pathway regulating fibrosis and macrophage polarization during biofilm formation. Together these findings represent a novel example of the divergence between TLR and MyD88 action in the context of S. aureus biofilm infection.
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Affiliation(s)
- Mark L. Hanke
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Amanda Angle
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Tammy Kielian
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
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11
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Rocha A, Rodrigues A, Teixeira L, Carvalho MJ, Mendonça D, Cabrita A. Temporal trends in peritonitis rates, microbiology and outcomes: the major clinical complication of peritoneal dialysis. Blood Purif 2012; 33:284-91. [PMID: 22572743 DOI: 10.1159/000337377] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 02/20/2012] [Indexed: 01/24/2023]
Abstract
Peritonitis remains a common complication of peritoneal dialysis (PD). The aim of this study was to analyze, in a PD center, long-term temporal trends in peritonitis rates, microbiology and outcomes. We treated 588 cases of peritonitis that occurred during 11,833.6 months at risk. Y-set and twin-bag disconnecting systems were introduced in 1990, mupirocin at the exit site in 2000 and fluconazole prophylaxis in 2005. Vancomycin and ceftazidime were the empiric protocol. Global and 5-year cohort rates were expressed as episodes/patient-year (ep/p-y). A global peritonitis rate reduction was found from 1.02 to 0.47 ep/p-y (p = 0.008). Poisson analyses performed in each of the subgroups of Gram-positive and Gram-negative peritonitis revealed no significant changes over time. No case of vancomycin resistance was identified. There was a downward trend in peritonitis-related hospitalization over time to 0.11 ep/p-y (p ≤ 0.001). Trend analysis showed a favorable, but changing evolution, highlighting the importance of accurate longitudinal PD center registry data and quality control.
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Affiliation(s)
- Ana Rocha
- Nephrology Department, CHP-Hospital Santo Antonio, Porto, Portugal.
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12
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Hanke ML, Kielian T. Deciphering mechanisms of staphylococcal biofilm evasion of host immunity. Front Cell Infect Microbiol 2012; 2:62. [PMID: 22919653 PMCID: PMC3417388 DOI: 10.3389/fcimb.2012.00062] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 04/20/2012] [Indexed: 12/19/2022] Open
Abstract
Biofilms are adherent communities of bacteria contained within a complex matrix. Although host immune responses to planktonic staphylococcal species have been relatively well-characterized, less is known regarding immunity to staphylococcal biofilms and how they modulate anti-bacterial effector mechanisms when organized in this protective milieu. Previously, staphylococcal biofilms were thought to escape immune recognition on the basis of their chronic and indolent nature. Instead, we have proposed that staphylococcal biofilms skew the host immune response away from a proinflammatory bactericidal phenotype toward an anti-inflammatory, pro-fibrotic response that favors bacterial persistence. This possibility is supported by recent studies from our laboratory using a mouse model of catheter-associated biofilm infection, where S. aureus biofilms led to the accumulation of alternatively activated M2 macrophages that exhibit anti-inflammatory and pro-fibrotic properties. In addition, relatively few neutrophils were recruited into S. aureus biofilms, representing another mechanism that deviates from planktonic infections. However, it is important to recognize the diversity of biofilm infections, in that studies by others have demonstrated the induction of distinct immune responses during staphylococcal biofilm growth in other models, suggesting influences from the local tissue microenvironment. This review will discuss the immune defenses that staphylococcal biofilms evade as well as conceptual issues that remain to be resolved. An improved understanding of why the host immune response is unable to clear biofilm infections could lead to targeted therapies to reverse these defects and expedite biofilm clearance.
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Affiliation(s)
| | - Tammy Kielian
- Department of Pathology and Microbiology, University of Nebraska Medical Center, OmahaNE, USA
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13
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Crabtree JH, Burchette RJ. Comparative analysis of two-piece extended peritoneal dialysis catheters with remote exit-site locations and conventional abdominal catheters. Perit Dial Int 2011; 30:46-55. [PMID: 20056979 DOI: 10.3747/pdi.2009.00004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND An alternative peritoneal catheter exit-site location is sometimes needed in patients with obesity, floppy skin folds, intestinal stomas, urinary and fecal incontinence, and chronic yeast intertrigo. Two-piece extended catheters permit remote exit-site locations away from problematic abdominal conditions. OBJECTIVE The effect on clinical outcomes by remotely locating catheter exit sites to the upper abdomen or chest was compared to conventional lower abdominal sites. METHODS In a nonrandomized design, peritoneal access was established with 158 extended catheters and 270 conventional catheters based upon body habitus and special clinical needs. Prospective data collection included patient demographics, infectious and mechanical complications, and catheter survival. RESULTS Kaplan-Meier survival time until first exit-site infection was longer for extended catheters (p = 0.03). Poisson regression showed no difference in exit site, subcutaneous tunnel, and peritonitis infection rates; however, the proportion of catheters lost during peritonitis episodes was significantly greater for extended catheters (p = 0.007) and appeared to be due primarily to coagulase-negative staphylococcus organisms. Poisson regression showed interactions of body mass index (BMI) and diabetic status in determining catheter loss from peritonitis for both catheter types (p = 0.02). Extended catheter patients had higher BMI and diabetes prevalence (p < 0.0001). Overall extended catheter survival at 1, 2, and 3 years (92%, 80%, 71%) trended lower than conventional devices (93%, 87%, 80%; p = 0.0505). CONCLUSIONS Extended catheters enable peritoneal access for patients in whom conventional catheter placement would be difficult or impossible. Certain patient and extended-catheter characteristics may contribute to loss from peritonitis.
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Affiliation(s)
- John H Crabtree
- Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Downey Medical Center, Downey, California, USA.
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14
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Marcus RJ, Post JC, Stoodley P, Hall-Stoodley L, McGill RL, Sureshkumar KK, Gahlot V. Biofilms in nephrology. Expert Opin Biol Ther 2008; 8:1159-66. [PMID: 18613767 DOI: 10.1517/14712598.8.8.1159] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Biofilms are bacterial communities ubiquitous to moist environments. Biofilm formation is a factor in the development and persistence of infectious diseases. In clinical nephrology, biofilms influence the development of kidney stones and affect dialysis systems, including peritoneal and central venous catheters. Biofilms also play critical roles in persistent and resistant renal and urinary tract infections. OBJECTIVE To describe the physiology of biofilms and potential effects of biofilms upon infectious diseases, focusing on the role of biofilms in kidney stones, indwelling catheters and dialysis equipment. METHODS A literature search with Medline to identify pertinent English language articles published up to early 2008 using the keywords biofilm, nephrology, renal, calculi and infection. RESULTS/CONCLUSION Biofilms are ubiquitous in clinical nephrology and play a role in the pathogenesis of resistant infections. Strategies for reducing the effects of biofilms in nephrology are described.
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Affiliation(s)
- Richard J Marcus
- Division of Nephrology & Hypertension, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
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15
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Buyne O, van Goor H, Bleichrodt R, Verweij P, Hendriks T. Both tissue-type plasminogen activator and urokinase prevent intraabdominal abscess formation after surgical treatment of peritonitis in the rat. Surgery 2008; 144:66-73. [DOI: 10.1016/j.surg.2008.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Accepted: 03/31/2008] [Indexed: 11/25/2022]
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16
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Buyne OR, Bleichrodt RP, van Goor H, Verweij PE, Hendriks T. Tissue-type plasminogen activator prevents formation of intra-abdominal abscesses after surgical treatment of secondary peritonitis in a rat model. Int J Colorectal Dis 2007; 22:819-25. [PMID: 17089129 DOI: 10.1007/s00384-006-0222-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND Optimal therapy of secondary peritonitis frequently results in the formation of residual abscesses, which bear a substantial mortality and morbidity. This study aims to prove that fibrinolytic therapy with recombinant tissue plasminogen activator (rtPA) can reduce abscess formation after surgical treatment of secondary peritonitis in a rat model, without causing unwanted side effects. MATERIALS AND METHODS Male Wistar rats received an intra-abdominal injection with a suspension of sterile feces, 10(5) cfu Escherichia coli and 10(4) cfu Bacteroides fragilis. Surgical debridement was performed 1 h after inoculation. Animals were randomized into four groups (n = 14 each). Three groups received human rtPA at 1 h (rtPA1); 1 h and 6 h (rtPA2); and 1, 6, and 24 h (rtPA3), respectively. Each dose contained 1.25 mg rtPA. Controls received saline only. Animals were killed after 5 days. RESULTS rtPA treatment reduced abscess formation in surviving animals, depending on number of doses given. Animals in group rtPA3 had no abscesses in contrast to 88% of the controls (mean 3.6 +/- 2.7 abscesses per rat; p < 0.05). In the rtPA1 and rtPA2 group, frequency of abscess formation was 58 and 33%, respectively. Mortality, course of body weight, and bacteremia were not affected by rtPA and neither were peritoneal cell counts and levels of TNF-alpha, IL-1beta, IL-6 and IL-10. No bleeding complications were observed. CONCLUSION rtPA reduces intra-abdominal abscess formation after surgical treatment of generalized peritonitis without increasing mortality or affecting the local inflammatory response.
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Affiliation(s)
- Otmar R Buyne
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 91091, 6500, HB Nijmegen, The Netherlands
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17
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Abstract
Biofilm/bioslime is a complex, dynamically interactive multicellular community protected within a heterogeneous exopolysaccharide matrix. Its formation results in the genesis or perpetuation of infection, enhancement of inflammation, and tissue damage or death. Industrial financial losses result from biofilm/bioslime formation; however, the consequences in the medical realm are equally devastating. The relation of biofilm to patients with chronic kidney disease is often covert and extends beyond the colonization of hemodialysis circuits and vascular accesses. Urinary tract device- and vascular access-related biofilms may also increase the burden of cardiovascular risk borne by chronic kidney disease patients, synergizing with the chronic inflammatory state already incurred by these individuals. Current anti-infective strategies are aimed at rapidly killing planktonic forms of microorganisms without specifically targeting the sessile forms that perpetuate their planktonic brethren. Future treatments of infections must ultimately target these reservoirs of infection aiming for their complete eradication. Presently, included among these novel weapons of microdestruction are molecular blockading techniques, electrical enhancement of anti-infectives, and bacterial interference. Nonetheless, the best approach against biofilm formation remains the prevention of microbial colonization, which can be largely by sterile handling of patient-related devices, the most well-established biofilm reservoirs.
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Affiliation(s)
- Gino Tapia
- Department of Medicine, Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI 48202, USA
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Krishnan RG, Moghal NE. Tissue plasminogen activator for blocked peritoneal dialysis catheters. Pediatr Nephrol 2006; 21:300. [PMID: 16252099 DOI: 10.1007/s00467-005-2070-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Accepted: 07/21/2005] [Indexed: 10/25/2022]
Abstract
Tissue plasminogen activator was used for a blocked peritoneal dialysis catheter in a child with no vascular access. The catheter was salvaged using tissue plasminogen activator and dialysis could be carried out without any difficulty.
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Diamond IR, Wales PW, Connolly B, Gerstle T. Tissue plasminogen activator for the treatment of intraabdominal abscesses in a neonate. J Pediatr Surg 2003; 38:1234-6. [PMID: 12891500 DOI: 10.1016/s0022-3468(03)00275-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Fibrinolytic agents have been used successfully in the management of loculated empyema; however, their use in the treatment of intraabdominal abscesses is limited. The authors describe the case of a 4-week-old girl with intraabdominal abscesses secondary to intestinal perforation that were not amenable to percutaneous drainage, but were managed successfully with intracavitary administration of tissue-plasminogen activator. This case represents the first report in a human, in which tissue-plasminogen activator was used to facilitate percutaneous drainage of an intraabdominal abscess. It is also the first time a fibrinolytic agent has been used for this purpose in a child.
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Affiliation(s)
- Ivan R Diamond
- Division of Pediatric General Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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20
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Abstract
Biofilm bacterial infections are implicated in most human bacterial infections and are also common in patients undergoing treatment with hemodialysis and peritoneal dialysis. Skin bacteria, which grow into microcolonies with biofilm formation in dialysis environments, are implicated in most of these infections. Dissemination of bacterial biofilms in hemodialysis patients induces bacteremia and endotoxemia. In peritoneal dialysis patients, biofilm causes peritonitis and catheter-related infections with consequent loss of catheters and technique failure. Effective strategies for the diagnosis, intervention, and prevention of biofilm-related infections in dialysis patients are described in this review.
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Affiliation(s)
- Mrinal K Dasgupta
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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21
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Sherman RA. Briefly Noted. Semin Dial 2001. [DOI: 10.1046/j.1525-139x.2001.00074.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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