An in vitro study of the efficacy of rifampicin and minocycline coated umbilical venous catheters

The potential for developing new antimicrobial resistance from the use of medical devices containing chlorhexidine, minocycline, rifampicin and their combinations: a systematic review

Background

Catheter infections remain one of the most persistent adverse events causing significant morbidity, economic impact and mortality. Several strategies have been proposed to reduce these infections including the use of catheters embedded with antibiotics and/or antiseptics. One reoccurring challenge is the fear that antimicrobial medical devices will induce resistance. The aim of this systematic review is to evaluate the evidence for induced antimicrobial resistance caused by exposure to antimicrobial medical devices.

Methods

Four electronic databases [MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus] were screened for studies published between 1983 and 2019 regarding assessment of microbial resistance with use of medical devices containing chlorhexidine, minocycline, rifampicin or combinations thereof. Development of new resistance, selection for tolerant organisms and 'no change in resistance' were assessed.

Results

Forty-four publications, grouped by study type and stratified by drug assessed, were included for analyses. The majority of studies found no change in resistance after exposure to antimicrobial medical devices (13 in vitro, 2 in vivo, 20 clinical). Development of new resistance was commonly reported with the use of rifampicin as a single agent and only reported in one study assessing the minocycline/rifampicin combination (M/R); however, the increase in MIC was well below clinical relevance.

Conclusions

Emergence of new resistance to combinations of M/R, minocycline/rifampicin/chlorhexidine (M/R/CH) and chlorhexidine/silver sulfadiazine (CHXSS) was rare. No clinical trials confirmed its occurrence and some refuted it. The risk of development of new resistance to these antimicrobial combinations appears more fear-based than substantiated by clinical and experimental evidence but warrants continued surveillance.

Allicin prevents the formation of Proteus-induced urinary crystals and the blockage of catheter in a bladder model in vitro

Stone formation and catheter blockage are major complications of Proteus UTIs. In this study, we investigated the ability of allicin to inhibit P. mirabilis-induced struvite crystallization and catheter blockage using a synthetic bladder model. Struvite crystallization inhibition study was carried out using P. mirabilis lysate as urease enzyme source in synthetic urine (SU). Struvite productions were monitored by phase contrast light microscopy and measurements of pH, Mg²⁺ and Ca²⁺ precipitation and turbidity. A catheter blockage study was performed in a synthetic bladder model mimicking natural UTI in the presence of allicin at sub-MIC concentrations (MIC = 64 μg/ml). The results of crystallization study showed that allicin inhibited pH rise and consequently turbidity and precipitation of ions in a dose-dependent manner. The results of catheter blockage study showed that allicin at sub-MIC concentrations (2, 4, 8 μg/ml) significantly increased the time for catheter blockage to occur to 61, 74 and 92 h respectively compared to allicin-free control (48 h). In a similar way, the results showed that allicin delayed the increase of SU pH level in bladder model in a dose-dependent manner compared to allicin-free control. The results also showed that following the increase of allicin concentration, Mg²⁺ and Ca²⁺ deposition in catheters were much lower compared to allicin-free control, further confirmed by direct observation of the catheters' eyehole and cross sections. We conclude that allicin prevents the formation of Proteus-induced urinary crystals and the blockage of catheters by delaying pH increase and lowering Mg²⁺ and Ca²⁺ deposition in a dose-dependent manner.

The effect of self-assembled layers on the release behavior of rifampicin-loaded silicone

Providing a long period of sustained antibiotic release is one of the important challenges in the development of clinical shunts for long-term implantation. A cast-molding approach was used to load rifampicin into the silicone precursor before curing. Sustained in vitro release from rifampicin-loaded silicone for upwards of 110 days at a level of approximately 2-4 microg/cm2 per day was achieved. Quantitative comparisons of Staphylococcus epidermidis adhesion on untreated and rifampicin-loaded silicone surfaces were carried out to demonstrate the effect of rifampicin to discourage the bacterial adhesion. It was shown that the fresh 8.3% rifampicin-loaded silicone decreased bacterial adherence by 99.8%. Bacterial adherence on rifampicin-loaded silicone surfaces after 90 days release (eluted silicone) was decreased by 94.8%. A new approach was used to tune the initial burst effect and prolong long lasting release by introducing self-assembled perfluorodecyltrichlorosilane (FAS) and octadecyltrichlorosilane (OTS) layers. FAS layered structures can tune the burst effect and prolong the subsequent continuous release to achieve the long-term delivery. Significant decreases in initial burst effect (70.3% for multi-FAS layers and 39.7% for FAS monolayer) and enhanced long-term release (approx. 10 microg/cm2 per day for FAS monolayer for 110 days and approx. 15 microg/cm2 per day for multi-FAS layers for 60 days) were observed.

Infection control issues in central venous catheter care

Central venous catheters (CVCs) are now a routine part of patient management in the intensive care unit (ICU). Over time, a vast amount of literature associated with the use and care of CVCs has accumulated. The purpose of this article is to discuss the literature associated with the care of these devices in a narrative format. Although particular attention is paid to infection control issues, other fundamental areas such as catheter design, dressings, line changing and post insertion management are also discussed. The article goes on to look at the future of CVC design and concludes with an analysis of future developments related to CVCs.