Update on the challenging role of biofilms in peritoneal dialysis

Abstract

Biofilms are commonly associated with an increased risk of patient infection. In peritoneal dialysis (PD), catheter associated infection, especially peritonitis, remains a clinically relevant problem. Although the presence of a biofilm is recognized in relapsing, repeat, and catheter-related peritonitis, it remains poorly characterized. In this review, an update on the role of biofilms in PD infections is presented. The emerging concept that host cells and tissue associated biofilms, in addition to the biofilms on the catheters themselves, contribute to the recalcitrance of infections is discussed. Furthermore, the evidence of biofilms on PD catheters, their developmental stages, and the possible influence of the PD environment are reviewed. The focus is given to ex vivo and in vitro studies that contribute to the elucidation of the interplay between host, microbial, and dialysis factors. The key issues that are still to be answered and the challenges to clinical practice are discussed.

Keywords:

• biofilm
• peritoneal dialysis
• infection
• catheter
• host cells/tissues

Acknowledgments

M. Martins is financially supported by a fellowship from the Portuguese Foundation for Science and Technology (contract SFRH/BPD/73663/2010), financed by the European Social Fund and national funds from the Ministry of Education and Science. The authors are grateful to the Portuguese Society of Nephrology for financial support. The authors are indebted to the staff of the Department of Nephrology of Hospital de Santo António, Centro Hospitalar do Porto, namely Olívia Santos, for sample collection.

Notes

Professor Rosário Oliveira passed away just after accomplishing the design and revision of this manuscript. She will always be remembered as an exceptional scientist, teacher, and a true friend. She dedicated her scientific life to biofilm science being the founder and the soul of the UMinho Biofilm Group.