{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T19:32:22Z","timestamp":1791401542429,"version":"4.3.3"},"reference-count":94,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:p>\n                    The management of fungal catheter-related bloodstream infections (CRBSIs) in the hemodialysis population represents a critical collision between rigorous infectious disease guidelines and the grim clinical reality of vascular access exhaustion. While guidelines from the IDSA and KDIGO unequivocally recommend immediate catheter removal to prevent metastatic complications, nephrologists are frequently confronted with patients for whom the current catheter represents the last viable lifeline. This review provides a comprehensive analysis of the \u201ccatheter salvage\u201d dilemma, moving beyond superficial treatment algorithms to explore the molecular and structural mechanisms that make fungal biofilms a formidable adversary. We dissect the pathogenesis of\n                    <jats:italic>Candida<\/jats:italic>\n                    colonization on abiotic surfaces (silicone and polyurethane), detailing the transition from yeast to hyphal structures and the secretion of a complex extracellular matrix (ECM). We highlight how the ECM, rich in \u03b2-1,3 glucan, acts as a physical shield that sequesters azoles, rendering standard systemic therapy ineffective despite\n                    <jats:italic>in vitro<\/jats:italic>\n                    susceptibility. Furthermore, we discuss the role of metabolically dormant \u201cpersister cells\u201d in driving high relapse rates and analyze the epidemiological shift toward\n                    <jats:italic>Candida parapsilosis<\/jats:italic>\n                    , a pathogen with a unique affinity for foreign bodies and parenteral nutrition lines. Diagnostically, we scrutinize the limitations of traditional blood cultures and the \u201cDifferential Time to Positivity\u201d (DTP) criteria, arguing that the slower growth kinetics of fungi render DTP unreliable compared to bacterial infections. The core of this review evaluates the efficacy and safety of Antifungal Lock Therapy (ALT) as a bridging strategy. We provide a comparative analysis of lock agents, contrasting the broad lytic potential of ethanol (the \u201cnuclear option\u201d) with the safety profile of taurolidine and the pharmacological nuances of amphotericin B and echinocandins. Ultimately, we propose that while catheter removal remains the gold standard, a nuanced mastery of biofilm biology and lock therapy protocols is essential for managing complex, access-challenged patients where immediate removal is not feasible.\n                  <\/jats:p>","DOI":"10.3389\/fcimb.2026.1774864","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T06:57:54Z","timestamp":1773817074000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["The fungal stronghold: biofilms in hemodialysis catheters, diagnostic pitfalls, and the challenge of catheter salvage"],"prefix":"10.3389","volume":"16","author":[{"given":"Jie","family":"Shi","sequence":"first","affiliation":[{"name":"Department of Disease Control and Prevention, Naval Medical Center of People's Liberation Army (PLA), Naval Medical University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naiying","family":"Lan","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Naval Medical Center of People's Liberation Army (PLA), Naval Medical University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanzhou","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Naval Medical Center of People's Liberation Army (PLA), Naval Medical University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanmei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Naval Medical Center of People's Liberation Army (PLA), Naval Medical University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University","place":["Augusta, GA, United States"]},{"name":"Department of Nephrology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Naval Medical Center of People's Liberation Army (PLA), Naval Medical University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"457","DOI":"10.3390\/pathogens4030457","article-title":"Elimination of bloodstream infections associated with candida albicans biofilm in intravascular catheters","volume":"4","author":"Akbari","year":"2015","journal-title":"Pathogens"},{"key":"B2","doi-asserted-by":"publisher","first-page":"220","DOI":"10.56061\/FBUJOHS.1470944","article-title":"Evaluation of the effect of ethyl alcohol solutions in different concentrations on bacteria","volume":"4","author":"Ak\u0131nc\u0131","year":"2024","journal-title":"Fenerbah\u00e7e Univ. 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