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Confocal laser scanning microscopy of peritoneal catheter surfaces.

Surface topography of used (in situ > 12 months) and unused CAPD catheters was studied by scanning electronmicroscopy (SEM) and confocal laser scanning microscopy (CLSM). Microbial biofilm was observed on all used catheters. Disruption and removal of the attached biofilm revealed extensive pitting of the catheter surface and scoring within the catheter pores. Similar, though less extensive, surface defects were present in unused catheters. Examination by CLSM, with software specific to the determination of surface topography, showed used catheters to have a surface microrugosity greater than that of unused catheters (p < 0.0005). Adherence studies with radiolabelled Staphylococcus epidermidis demonstrated increased adherence to used than to unused catheters (p < 0.0005) after 48 h. However, when catheters were pre-treated with spent dialysate there was a substantial reduction in bacterial adherence to either catheter and no significant difference in adherence to used and unused catheters. Surface microrugosity of CAPD catheters increases during use but is unlikely to be an important factor in bacterial adherence in vivo.