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NDT Advance Access published online on November 23, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp638
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© The Author 2009. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


The role of polymer surface degradation and barium sulphate release in the pathogenesis of catheter-related infection

Francis Verbeke1, Ulrike Haug2, Annemieke Dhondt1, Werner Beck2, Andrea Schnell2, Ruth Dietrich2, Reinhold Deppisch2 and Raymond Vanholder1

1 University Hospital Ghent—Department of Internal Medicine, Nephrology section, De Pintelaan 185, 9000 Ghent, Belgium 2 Gambro Research, Gambro Dialysatoren GmbH, Holger-Crafoord Street 26, 72379 Hechingen, Germany

Correspondence and offprint requests to: Francis Verbeke; E-mail: francis.verbeke{at}UGent.be



  Abstract

Background. Susceptibility to infection and thrombosis of intravascular catheters is increased by surface irregularities, which might be prevented by coating.

Methods. BaSO4 release from conventional haemodialysis catheters (CC) and modified catheters (MC) which had been coated with a surface-modifying additive (SMA) was assessed in vivo and in vitro. For the in vivo part, patients were randomized to receive a temporary CC or MC, with crossover after 1 week. After retrieval, catheters were examined using scanning electron microscopy to assess surface integrity, and an in vitro model of catheter exposure to the bloodstream was used to evaluate surface morphology and susceptibility to bacterial adhesion and proliferation.

Results. BaSO4 moieties covered 14.7 ± 3.7% of the surface of unused CC. After in vivo use in 16 patients, 62.7 ± 32.9 x 103 holes/mm2 were detected, indicating BaSO4 detachment from 3.3 ± 1.7% of the catheter surface. No defects were observed in unused CC and in MC, whether used or unused. After incubation of four catheters (two of each type) with Staphylococcus epidermidis, the two degraded CC showed an immediate and strong bacterial growth as indicated by an increase in medium impedance of 0.512%/10 min compared to –0.021%/10 min in MC (P < 0.001).

Conclusions. Short-term exposure of CC to the bloodstream causes BaSO4 particle release, resulting in surface irregularities predisposing to bacterial proliferation. BaSO4 release can be prevented by SMA coating.

Keywords: catheter infection; haemodialysis; polydimethylsiloxane; surface modification; surface roughness

Received for publication: 10. 4.09
Accepted in revised form: 2.11.09


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