Liu Aichun, Zhao Huiping, Wu Bei, Zheng Shuying, Zuo Li, Wang Mei
Department of Nephrology, Peking University People's Hospital, Beijing 100044, China.
Department of Laboratory of Electron Microscope, Peking University People's Hospital, Beijing 100044, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2025 Feb 18;57(1):161-165. doi: 10.19723/j.issn.1671-167X.2025.01.024.
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.
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.
(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 , methicillin-sensitive (MSSA), and . (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 (, , , ), , ( and ).
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.
腹膜透析（PD）相关腹膜炎是PD常见且主要的并发症，也是PD技术失败最常见的原因。细菌生物膜的存在可能是导致腹膜炎难治或复发的重要因素。探讨腹膜炎相关导管拔除后PD导管上细菌生物膜的形成及特征。
回顾性分析2007年6月至2022年1月在北京大学人民医院规律随访的维持性PD患者。选取因腹膜炎退出PD并在我院拔除PD导管且接受导管扫描电子显微镜检查的患者。总结患者的一般资料、PD导管的电子显微镜检查结果及PD液的细菌培养结果。
（1）共纳入18例患者，其中女性11例（占61.1%）。患者平均年龄为（59.1±11.5）岁，平均透析时间为（80.1±47.4）个月。原发性肾脏疾病以慢性肾小球肾炎为主（55.6%），其次为糖尿病肾病（27.8%），其他（16.6%）。18例患者拔除导管的原因中，难治性腹膜炎11例，复发性腹膜炎5例，真菌性腹膜炎2例。（2）18例患者中有16例（88.9%）存在导管细菌生物膜，细菌生物膜形态均为球菌。部分呈葡萄样排列，直径约500 nm至1 000 nm。腹膜透析液细菌培养结果显示，最常见的三种病原体为甲氧西林敏感金黄色葡萄球菌（MSSA）等。（3）纳入的18例患者中，13例（72.2%）既往有腹膜炎。9例腹膜炎致病菌为球菌，包括凝固酶阴性葡萄球菌（表皮葡萄球菌、溶血葡萄球菌、头状葡萄球菌、人葡萄球菌）、金黄色葡萄球菌、肠球菌（粪肠球菌和屎肠球菌）。
腹膜炎相关导管拔除患者中，PD导管内表面细菌生物膜形成较为常见。并非所有因腹膜炎拔除的PD导管都有细菌生物膜。细菌生物膜与腹膜炎病原体可能不一致。
