Microbial colonization of indwelling and implantable medical devices and prostheses is known to precede the formation of an adherent biofilm, such as is found on peritoneal catheters during CAPD. Micro-organismderived exopolysaccharides within the biofilm matrix seem to confer unique biological properties on this material, such as enhanced resistance to host defenses and antimicrobial agents. It has been proposed that an adherent biofilm is a major contributing factor in the development of foreign-body infections, including CAPD peritonitis. The source of organisms which lead to biofilm formation on peritoneal catheters is unknown but may include “seeding” at the time of surgical placement and migration from the subcutaneous tunnel via the inner cuff.
Strategies to inhibit biofilm development in industrial systems usually involve physical destruction of the biofilm and the use of biocides. Clinical success has been achieved by antimicrobial agents impregnated into or coated onto susceptible devices. Microbial adhesion to inanimate surfaces is a complex and multifaceted event. Continued research in this area, however, should increase our understanding of the factors involved underlying foreignbody infection.
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