[Formation of bacterial biofilm on deep vein catheters in burn patients and its significance].
OBJECTIVE
To observe the biofilm (BF) formation of Staphylococcus aureus (SA), Acinetobacter baumannii (AB) and Pseudomonas aeruginosa (PA) on the surface of deep vein catheters in burn patients after infection.


METHODS
The bacteria from deep vein catheters in 20 patients hospitalized from November 2008 to August 2009 were isolated, and were compared with their respective standard stains. Catheters tips were examined with scanning electron microscope (SEM). The semi-quantitative adhesion assay of bacterial BF was performed with modified microtiter-plate test, and the thickness of BF was scanned and measured by confocal laser scanning microscopy (CLSM) after double fluorescence staining, after being cultured in vitro for 12, 24, 48, 72 hours and 5 days, respectively. Data were processed with grouped t test.


RESULTS
Six strains of SA, 8 strains of AB, and 6 strains of PA, all drug resistant, were isolated from the deep vein catheters. SEM showed that the BF structures on the inner surfaces of catheters were in diverse in their shape and degree, characterized by adherence and flake formation, and embedded in polysaccharide matrix. BF gathered in clusters, forming three-dimensional structure, in which small amount of red blood cells were found. A small number of bacteria were incompletely embedded, with some bacteria adhered to them. The absorbance values for SA after 24, 48 and 72 hours of culture (PCH) were above the cut-off value, the same for AB at PCH 12, 24, 48 and 72, and PA after PCH 48. Except for PA standard strain, CLSM showed scattered green fluorescence, mainly close to the bottom of plate, while the red fluorescence was observed in full scope at PCH 24 for each strain. At PCH 48 green fluorescence increased obviously and extended upward from the bottom, overlapping partly with red fluorescence, forming yellow fluorescence, and among the bacteria it was most obvious in AB culture, with SA the next. Compared with those of the standard stains, the intensity and quantity of fluorescence from the clinical strains were stronger; at PCH 72 the green fluorescence increased obviously especially for PA and its standard strain, while the yellow fluorescence was full of the scope for other strains. On in vitro culture day 5, the green fluorescence was dispersed and was obvious on the bottom of the plate. BF mature time for AB and SA was PCH 48, and for PA was PCH 72. The BF thickness of AB was (18.2 +/- 3.6) microm at PCH 72, which was thicker than that [(9.4 +/- 2.6) microm] of its standard strain (t = 5.42, P < 0.05), and was also the thickest among the three clinically found strains.


CONCLUSIONS
SA, AB and PA, which are commonly found bacteria in burn patients, can form BF in deep vein catheters. Their ability to form BF seems to be stronger than other usually pathogenic strains, especially AB, which is the important pathogen leading to catheter related infection.
Xiang
Jun
J
Department of Burns and Plastic Surgery, Medical College of Shanghai Jiao Tong University, Shanghai, China.
Sun
Zhen
Z
Song
Fei
F
Han
Li-zhong
LZ
Huan
Jing-ning
JN
D000151:Acinetobacter Infections / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000254:growth & development; D001422:Bacterial Adhesion; D018441:Biofilms; D002056:Burns / Q000382:microbiology*; D057785:Catheters / Q000382:microbiology*; D006801:Humans; D011552:Pseudomonas Infections / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000254:growth & development; D013203:Staphylococcal Infections / Q000382:microbiology*; D014680:Veins / Q000382:microbiology