Mechanisms of microbial colonization in biofilm-associated infections of hemodialysis catheters and advances in surface modification technologies.

SUMMARYHemodialysis catheter-related bloodstream infections (CRBSIs), primarily driven by microbial colonization and biofilm formation, represent a major cause of morbidity and mortality in patients with end-stage renal disease. Key pathogens such as Staphylococcus aureus and Pseudomonas aeruginosa employ sophisticated virulence mechanisms, including microbial surface components recognizing adhesive matrix molecules (MSCRAMMs) and quorum-sensing (QS) systems, to establish resilient biofilms. Surface modification technologies-encompassing antibacterial coatings, antithrombotic modifications, antibiofilm technologies, surface topological optimization, and tip design innovations-offer promising "anti-colonization" strategies to prevent infections. Notably, while tunneled and non-tunneled catheters exhibit distinct biofilm dynamics and clinical risk profiles, emerging multifunctional coatings demonstrate the potential for enhancing long-term catheter safety and performance. However, the clinical translation of these innovations requires overcoming challenges related to biocompatibility, long-term durability, and scalable manufacturing, necessitating interdisciplinary collaboration.