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a List of organisms is based upon the following references: Aufwerber et al. 1991; Anaissie et al. 1995; Darouiche et al. 1999; Maki et al. 1997; Kamal et al. 1991; Kowalewska-Grochowska et al. 1991; Flowers et al. 1989; Brun-Buisson et al. 1987; Raad et al. 1993; Zuffrey et al. 1988; Moreno et al. 2006.

a List of organisms is based upon the following references: Aufwerber et al. 1991; Anaissie et al. 1995; Darouiche et al. 1999; Maki et al. 1997; Kamal et al. 1991; Kowalewska-Grochowska et al. 1991; Flowers et al. 1989; Brun-Buisson et al. 1987; Raad et al. 1993; Zuffrey et al. 1988; Moreno et al. 2006.

Fig. 2 Scanning electron microscopic image of the luminal surface of an explanted catheter containing a biofilm of Alcaligenes xylosoxidans in a fibrin-like matrix. Photo by Janice Carr

1998). Organisms may also originate through hematogenous seeding of the device from another nidus of infection in the catheterized patient (Anaissie et al. 1995). A listing of microorganisms that have been recovered from biofilms on CVCs removed from patients is shown in Table 1. For several of the studies represented by these data, multiple organisms were isolated from the same catheter biofilm. Platelets, plasma, and tissue proteins such as fibronectin, fibrin, and laminin will also adsorb to the CVC surface after it is exposed to the bloodstream (Raad 1998) and these materials will alter the surface characteristics and affect microbial attachment (Murga et al. 2001; Rupp et al. 1999). Figure 2 shows a biofilm containing bacilli embedded in a fibrin-like matrix on the surface of an explanted catheter. These organisms were also isolated from separate segments of the same catheter on microbiological media and identified as a pure culture of Alcaligenes xylosoxidans (R.M. Donlan, unpublished data).

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