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In 1981, intravenous catheters infected with staphylococci by perfusion were investigated by scanning electron microscopy (SEM) to demonstrate the mode of adhesion. Bacterial cells, primarily those of staphylococci, followed by Acinetobacter calcoaceticus and Pseudomonas aeruginosa, were shown to be attached to the inner surface of the catheter. The thickest bacterial layers were found in catheters infected by coagulase-negative staphylococci (CoNS). Right heart flow-directed catheters removed from 18 critically ill patients after an average of 2.6 days after insertion were covered by a bacterial biofilm. In a neonatal intensive care unit, CoNS caused the majority of the nosocomial bacteremias. A study of arterial and central venous catheters removed from patients after 1 to 14 days revealed an extensive biofilm on all 42 arterial and 26 central venous catheters. By using special biofilm culture recovery methods, it was shown that 81% of the catheters were colonized by bacteria growing in slime-enclosed biofilms. It was speculated that the colonization represents a nidus for infection and bacteremia in these patients. Staphylococci also produced biofilm on polyvinyl chloride (PVC) endotracheal tubes used in neonates. Adherence of staphylococci to various intravascular catheter materials was investigated; these materials were composed of silicone elastomer, thermoplastic polyurethane, and polyurethane coated with Hydromer, a coating that absorbs water and provides a hydrophilic sheath around the catheter. Production of slime is necessary for Staphylococcus epidermidis colonization and is also observed with many other pathogens, including S. aureus.
Scanning electron micrograph (magnification, × 5,000) of S. epidermidis KH11. Massive colonization and slime production on cellulose acetate after 24 h of cultivation are shown.
Two-step model of staphylococcal biofilm formation. The first step in biofilm formation is the adherence of the bacterial cells to a surface. The second step is the imbedding of the cells in a thick slime matrix (biofilm). One type of slime has been identified as PIA. Within this biofilm, cells appear to have reduced physiological activity in an anoxic environment, and exhibit a decreased sensitivity to many antibiotics, compared with their planktonic counterparts.
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