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Morphological analysis of biofilm of peritoneal dialysis catheter in refractory peritonitis patient

机译：难治性腹膜炎患者腹膜透析导管生物膜的形态学分析

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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.
机译：一名接受腹膜透析（PD）的66岁男子被送入我院治疗PD相关性腹膜炎。 PD液的培养表明存在弗氏柠檬酸杆菌，头孢他啶的治疗从腹膜内开始。在治疗的前2周中，PD液中的细胞计数随时间缓慢下降，但在第14住院日再次上升。 PD液体的第二次培养表明存在肠球菌。抗生素治疗改用万古霉素并不能改善PD液中的细胞计数。 PD液体的第三次培养表明嗜麦芽窄食单胞菌的存在。在第28个医院工作日中断PD，取下导管。对导管的检查表明，内尖端被一层纤维状细胞覆盖，表明形成了生物膜。拔出导管后，给患者静脉注射环丙沙星，炎性反应立即开始消失，在治疗1周后已完全消失。导管上纤维结构的显微镜分析显示了各种炎症细胞的多层。免疫染色揭示了面对导管腔的CD44阳性多核细胞的存在，表明中性粒细胞。在下一层观察到CD68阳性细胞，表明巨噬细胞，而角蛋白阳性细胞，表明腹膜间皮细胞，出现在结构的底部。根据导管拔除后PD相关性腹膜炎的即时改善，我们推测该生物膜有助于患者腹膜炎的难治性。导管的形态分析表明，间皮细胞和各种炎性细胞均可能促进了生物膜的发育。

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