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Gayani B, Dilhari A, Kottegoda N, Ratnaweera DR, Weerasekera MM. Reduced Crystalline Biofilm Formation on Superhydrophobic Silicone Urinary Catheter Materials. ACS OMEGA 2021; 6:11488-11496. [PMID: 34056304 PMCID: PMC8154006 DOI: 10.1021/acsomega.1c00560] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/09/2021] [Indexed: 05/14/2023]
Abstract
Crystalline biofilm formation in indwelling urinary catheters is a serious health problem as it creates a barrier for antibacterial coatings. This emphasizes the failure of antibacterial coatings that do not have a mechanism to reduce crystal deposition on catheter surfaces. In this study, trifluoropropyl spray-coated polydimethylsiloxane (TFP-PDMS) has been employed as an antibiofilm forming surface without any antibacterial agent. Here, TFP was coated on half-cured PDMS using the spray coating technique to obtain a durable superhydrophobic coating for a minimum five cycles of different sterilization methods. The crystalline biofilm-forming ability of Proteus mirabilis in artificial urine, under static and flow conditions, was assessed on a TFP-PDMS surface. In comparison to the commercially available silver-coated latex and silicone catheter surfaces, TFP-PDMS displayed reduced bacterial attachment over 14 days. Moreover, the elemental analysis determined by atomic absorption spectroscopy and energy-dispersive X-ray analysis revealed that the enhanced antibiofilm forming ability of TFP-PDMS was due to the self-cleaning activity of the surface. We believe that this modified surface will significantly reduce biofilm formation in indwelling urinary catheters and further warrant future clinical studies.
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Affiliation(s)
- Buddhika Gayani
- Department
of Chemistry, Faculty of Applied Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka
- Centre
for Advanced Material Research, Faculty of Applied Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka
| | - Ayomi Dilhari
- Department
of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka
| | - Nilwala Kottegoda
- Department
of Chemistry, Faculty of Applied Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka
- Centre
for Advanced Material Research, Faculty of Applied Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka
| | - Dilru R. Ratnaweera
- Department
of Chemistry, Faculty of Applied Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka
- Centre
for Advanced Material Research, Faculty of Applied Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka
| | - Manjula Manoji Weerasekera
- Department
of Chemistry, Faculty of Applied Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka
- Department
of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka
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Yuan F, Huang Z, Yang T, Wang G, Li P, Yang B, Li J. Pathogenesis of Proteus mirabilis in Catheter-Associated Urinary Tract Infections. Urol Int 2021; 105:354-361. [PMID: 33691318 DOI: 10.1159/000514097] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/26/2020] [Indexed: 11/19/2022]
Abstract
Proteus mirabilis (PM) is a Gram-negative rod-shaped bacterium and widely exists in the natural environment, and it is most noted for its swarming motility and urease activity. PM is the main pathogen causing complicated urinary tract infections (UTIs), especially catheter-associated urinary tract infections. Clinically, PM can form a crystalline biofilm on the outer surface and inner cavity of the urethral indwelling catheter owing to its ureolytic biomineralization. This leads to catheter encrustation and blockage and, in most cases, is accompanied by urine retention and ascending UTI, causing cystitis, pyelonephritis, and the development of bladder or kidney stones, or even fatal complications such as septicemia and endotoxic shock. In this review, we discuss how PM is mediated by a catheter into the urethra, bladder, and then rose to the kidney causing UTI and the main virulence factors associated with different stages of infection, including flagella, pili or adhesins, urease, hemolysin, metal intake, and immune escape, encompassing both historical perspectives and current advances.
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Affiliation(s)
- Fei Yuan
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ziye Huang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tongxin Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guang Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Pei Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bowei Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiongming Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China,
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Rubini D, Vedha Hari BN, Nithyanand P. Chitosan coated catheters alleviates mixed species biofilms of Staphylococcus epidermidis and Candida albicans. Carbohydr Polym 2020; 252:117192. [PMID: 33183634 DOI: 10.1016/j.carbpol.2020.117192] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/13/2022]
Abstract
Microorganisms which adhere to the surfaces of indwelling medical implants develop into a sessile microbial community to form monomicrobial or polymicrobial biofilms. Staphylococcus epidermidis and Candida albicans are the most common pathogens co-isolated from device mediated infections. Hence development of catheters coated with anti-fouling substances is of great interest. In this current study, chitosan, extracted from the shells of marine crab Portunus sanguinolentus was coated over the surface of the urinary catheters and checked for its efficacy to inhibit the adherence of both mono and mixed species biofilms. The Extracted Chitosan (EC) coated catheters showed profound activity in reducing the preformed biofilms and the other virulence factors of the pathogens like slime production in S. epidermidis and yeast to hyphal swtich in C. albicans. Furthermore, qPCR analysis showed that EC could downregulate the virulence genes in both the pathogens when grown as monospecies and mixed species biofilms.
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Affiliation(s)
- Durairajan Rubini
- Biofilm Biology Laboratory, Centre for Research on Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed University, Tirumalaisamudram, Thanjavur, 613 401 Tamil Nadu, India
| | - B Narayanan Vedha Hari
- Pharmaceutical Technology Laboratory, School of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur, 613 401 Tamil Nadu, India.
| | - Paramasivam Nithyanand
- Biofilm Biology Laboratory, Centre for Research on Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed University, Tirumalaisamudram, Thanjavur, 613 401 Tamil Nadu, India.
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Wasfi R, Hamed SM, Amer MA, Fahmy LI. Proteus mirabilis Biofilm: Development and Therapeutic Strategies. Front Cell Infect Microbiol 2020; 10:414. [PMID: 32923408 PMCID: PMC7456845 DOI: 10.3389/fcimb.2020.00414] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/06/2020] [Indexed: 01/21/2023] Open
Abstract
Proteus mirabilis is a Gram negative bacterium that is a frequent cause of catheter-associated urinary tract infections (CAUTIs). Its ability to cause such infections is mostly related to the formation of biofilms on catheter surfaces. In order to form biofilms, P. mirabilis expresses a number of virulence factors. Such factors may include adhesion proteins, quorum sensing molecules, lipopolysaccharides, efflux pumps, and urease enzyme. A unique feature of P. mirabilis biofilms that build up on catheter surfaces is their crystalline nature owing to their ureolytic biomineralization. This leads to catheter encrustation and blockage and, in most cases, is accompanied by urine retention and ascending UTIs. Bacteria embedded in crystalline biofilms become highly resistant to conventional antimicrobials as well as the immune system. Being refractory to antimicrobial treatment, alternative approaches for eradicating P. mirabilis biofilms have been sought by many studies. The current review focuses on the mechanism by which P. mirabilis biofilms are formed, and a state of the art update on preventing biofilm formation and reduction of mature biofilms. These treatment approaches include natural, and synthetic compounds targeting virulence factors and quorum sensing, beside other strategies that include carrier-mediated diffusion of antimicrobials into biofilm matrix. Bacteriophage therapy has also shown successful results in vitro for combating P. mirabilis biofilms either merely through their lytic effect or by acting as facilitators for antimicrobials diffusion.
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Affiliation(s)
- Reham Wasfi
- Department of Microbiology and Immunology, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), Giza, Egypt
| | - Samira M Hamed
- Department of Microbiology and Immunology, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), Giza, Egypt
| | - Mai A Amer
- Department of Microbiology and Immunology, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), Giza, Egypt
| | - Lamiaa Ismail Fahmy
- Department of Microbiology and Immunology, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), Giza, Egypt
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Pelling H, Nzakizwanayo J, Milo S, Denham EL, MacFarlane WM, Bock LJ, Sutton JM, Jones BV. Bacterial biofilm formation on indwelling urethral catheters. Lett Appl Microbiol 2019; 68:277-293. [PMID: 30811615 DOI: 10.1111/lam.13144] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 12/21/2022]
Abstract
Urethral catheters are the most commonly deployed medical devices and used to manage a wide range of conditions in both hospital and community care settings. The use of long-term catheterization, where the catheter remains in place for a period >28 days remains common, and the care of these patients is often undermined by the acquisition of infections and formation of biofilms on catheter surfaces. Particular problems arise from colonization with urease-producing species such as Proteus mirabilis, which form unusual crystalline biofilms that encrust catheter surfaces and block urine flow. Encrustation and blockage often lead to a range of serious clinical complications and emergency hospital referrals in long-term catheterized patients. Here we review current understanding of bacterial biofilm formation on urethral catheters, with a focus on crystalline biofilm formation by P. mirabilis, as well as approaches that may be used to control biofilm formation on these devices. SIGNIFICANCE AND IMPACT OF THE STUDY: Urinary catheters are the most commonly used medical devices in many healthcare systems, but their use predisposes to infection and provide ideal conditions for bacterial biofilm formation. Patients managed by long-term urethral catheterization are particularly vulnerable to biofilm-related infections, with crystalline biofilm formation by urease producing species frequently leading to catheter blockage and other serious clinical complications. This review considers current knowledge regarding biofilm formation on urethral catheters, and possible strategies for their control.
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Affiliation(s)
- H Pelling
- Department of Biology and Biochemistry, University of Bath, Claverton Down, Bath, UK
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - J Nzakizwanayo
- Department of Biology and Biochemistry, University of Bath, Claverton Down, Bath, UK
| | - S Milo
- Department of Chemistry, University of Bath, Claverton Down, Bath, UK
| | - E L Denham
- Department of Biology and Biochemistry, University of Bath, Claverton Down, Bath, UK
| | - W M MacFarlane
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - L J Bock
- National Infections Service, Public Health England, Porton Down, Salisbury, UK
| | - J M Sutton
- National Infections Service, Public Health England, Porton Down, Salisbury, UK
| | - B V Jones
- Department of Biology and Biochemistry, University of Bath, Claverton Down, Bath, UK
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Li M, Mitra D, Kang ET, Lau T, Chiong E, Neoh KG. Thiol-ol Chemistry for Grafting of Natural Polymers to Form Highly Stable and Efficacious Antibacterial Coatings. ACS APPLIED MATERIALS & INTERFACES 2017; 9:1847-1857. [PMID: 27991755 DOI: 10.1021/acsami.6b10240] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Bacterial contamination of surfaces and the associated infection risk is a significant threat to human health. Some natural antibacterial polymers with low toxicity are promising coating materials for alleviating pathogenic colonization on surfaces. However, widespread application of these polymers as antibacterial coatings is constrained by coating techniques which are not easily scalable due to stringent reaction conditions. Herein, thiol-ol reaction involving oxidative conjugation between thiol and hydroxyl groups is demonstrated as a facile technique to graft two natural polymer derivatives, agarose (AG) and quaternized chitosan (QCS), as antibacterial coatings on polymer and metal substrates. The substrate surfaces are first treated with oxygen plasma followed by UV-induced grafting of the polymers under atmospheric conditions. Dimercaprol, a FDA-approved drug, is used as both surface anchor and cross-linker of the polymer chains during grafting. The AG coating achieves >2 log reduction in Pseudomonas aeruginosa and Staphylococcus aureus biofilm formation, while the QCS coating reduces bacterial count from contaminated droplets on its surface by >95%. The coatings are noncytotoxic and exhibits a high degree of stability under conditions expected in their potential applications as antibacterial coating for biomedical devices (for AG), and for preventing pathogen transmission in the environment (for QCS).
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Affiliation(s)
- Min Li
- Department of Chemical and Biomolecular Engineering, National University of Singapore , Kent Ridge, Singapore 117576
| | - Debirupa Mitra
- Department of Chemical and Biomolecular Engineering, National University of Singapore , Kent Ridge, Singapore 117576
| | - En-Tang Kang
- Department of Chemical and Biomolecular Engineering, National University of Singapore , Kent Ridge, Singapore 117576
| | - Titus Lau
- National University Hospital , Kent Ridge, Singapore 117576
| | - Edmund Chiong
- National University Hospital , Kent Ridge, Singapore 117576
| | - Koon Gee Neoh
- Department of Chemical and Biomolecular Engineering, National University of Singapore , Kent Ridge, Singapore 117576
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Legendre G, Vallée-Réhel K, Linossier I, Faÿ F. Evaluation of ionically cross-linked chitosan coating aimed at eggs' protection. Int J Food Sci Technol 2014. [DOI: 10.1111/ijfs.12690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gaëlle Legendre
- Laboratoire de Biotechnologie et Chimie Marines (LBCM), EA3884; Université de Bretagne Sud (UBS), Université Européenne de Bretagne (UEB); BP92116 56321 Lorient Cedex France
| | - Karine Vallée-Réhel
- Laboratoire de Biotechnologie et Chimie Marines (LBCM), EA3884; Université de Bretagne Sud (UBS), Université Européenne de Bretagne (UEB); BP92116 56321 Lorient Cedex France
| | - Isabelle Linossier
- Laboratoire de Biotechnologie et Chimie Marines (LBCM), EA3884; Université de Bretagne Sud (UBS), Université Européenne de Bretagne (UEB); BP92116 56321 Lorient Cedex France
| | - Fabienne Faÿ
- Laboratoire de Biotechnologie et Chimie Marines (LBCM), EA3884; Université de Bretagne Sud (UBS), Université Européenne de Bretagne (UEB); BP92116 56321 Lorient Cedex France
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8
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Stickler DJ. Clinical complications of urinary catheters caused by crystalline biofilms: something needs to be done. J Intern Med 2014; 276:120-9. [PMID: 24635559 DOI: 10.1111/joim.12220] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This review is largely based on a previous paper published in the journal Spinal Cord. The care of many patients undergoing long-term bladder catheterization is complicated by encrustation and blockage of their Foley catheters. This problem stems from infection by urease-producing bacteria, particularly Proteus mirabilis. These organisms colonize the catheter forming an extensive biofilm; they also generate ammonia from urea, thus elevating the pH of urine. As the pH rises, crystals of calcium and magnesium phosphates precipitate in the urine and in the catheter biofilm. The continued development of this crystalline biofilm blocks the flow of urine through the catheter. Urine then either leaks along the outside of the catheter and the patient becomes incontinent or is retained causing painful distension of the bladder and reflux of urine to the kidneys. The process of crystal deposition can also initiate stone formation. Most patients suffering from recurrent catheter encrustation develop bladder stones. P. mirabilis establishes stable residence in these stones and is extremely difficult to eliminate from the catheterized urinary tract by antibiotic therapy. If blocked catheters are not identified and changed, serious symptomatic episodes of pyelonephritis, septicaemia and endotoxic shock can result. All types of Foley catheters including silver- or nitrofurazone-coated devices are vulnerable to this problem. In this review, the ways in which biofilm formation on Foley catheters is initiated by P. mirabilis will be described. The implications of understanding these mechanisms for the development of an encrustation-resistant catheter will be discussed. Finally, the way forward for the prevention and control of this problem will be considered.
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Affiliation(s)
- D J Stickler
- Cardiff School of Biosciences, Cardiff University, Cardiff, UK
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Guégan C, Garderes J, Le Pennec G, Gaillard F, Fay F, Linossier I, Herry JM, Fontaine MNB, Réhel KV. Alteration of bacterial adhesion induced by the substrate stiffness. Colloids Surf B Biointerfaces 2014; 114:193-200. [DOI: 10.1016/j.colsurfb.2013.10.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/26/2013] [Accepted: 10/08/2013] [Indexed: 11/28/2022]
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10
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The effect of octadecyl chain immobilization on the hemocompatibility of poly (2-hydroxyethyl methacrylate). Biomaterials 2012; 33:7677-85. [DOI: 10.1016/j.biomaterials.2012.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 07/02/2012] [Indexed: 11/22/2022]
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Faÿ F, Carteau D, Linossier I, Delbury M, Vallée-Réhel K. Joint-action of antifouling substances in copper-free paints. Colloids Surf B Biointerfaces 2012; 102:569-77. [PMID: 23104027 DOI: 10.1016/j.colsurfb.2012.08.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 08/29/2012] [Accepted: 08/30/2012] [Indexed: 01/29/2023]
Abstract
Due to the environmentally harmful impact of tributyltin self-polishing paints, there is a critical need of more ecological alternatives. The aim of the present work is to study the joint-action of three molecules chosen in order to combine the two modes of prevention: chemical and physical repelling of biofouling. This "hybrid" system is principally dedicated to disturb durable settlement of microfouling. Each component was chosen according to its specific properties: chlorhexidine is a bisdiguanide antiseptic with antibacterial activity, zinc peroxide is an inorganic precursor of high instable entities which react with seawater to create hydrogen peroxide, Tween 85 is a non ionic surfactant disturbing interactions between colonizing organisms and surface. Obtained results highlighted the interest on mixing such molecules to get additive action on antifouling efficiency.
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Affiliation(s)
- Fabienne Faÿ
- Laboratoire de Biotechnologie et Chimie Marines (LBCM), UE3884, Université de Bretagne Sud (UBS), Université Européenne de Bretagne (UEB), BP92116, 56321 Lorient cedex, France.
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12
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Stickler DJ, Feneley RCL. The encrustation and blockage of long-term indwelling bladder catheters: a way forward in prevention and control. Spinal Cord 2010; 48:784-90. [PMID: 20368711 DOI: 10.1038/sc.2010.32] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To review the literature showing that understanding how Foley catheters become encrusted and blocked by crystalline bacterial biofilms has led to strategies for the control of this complication in the care of patients undergoing long-term indwelling bladder catheterization. METHODS A comprehensive PubMed search of the literature published between 1980 and December 2009 was made for relevant articles using the Medical Subject Heading terms 'biofilms', 'urinary catheterization', 'catheter-associated urinary tract infection' and 'urolithiasis'. Papers on catheter-associated urinary tract infections and bacterial biofilms collected during 40 years of working in the field were also reviewed. RESULTS There is strong experimental and epidemiological evidence that infection by Proteus mirabilis is the main cause of the crystalline biofilms that encrust and block Foley catheters. The ability of P. mirabilis to generate alkaline urine and to colonize all available types of indwelling catheters allows it to take up stable residence in the catheterized tract in bladder stones and cause recurrent catheter blockage. CONCLUSION The elimination of P. mirabilis by antibiotic therapy as soon as it appears in the catheterized urinary tract could improve the quality of life for many patients and reduce the current expenditure of resources when managing the complications of catheter encrustation and blockage. For patients who are already chronic blockers and stone formers, antibiotic treatment is unlikely to be effective owing to the resistance of cells in the crystalline biofilms. Strategies such as increasing fluid intake with citrated drinks could control the problem until bladder stone removal can be organized.
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Affiliation(s)
- D J Stickler
- Cardiff School of Biosciences, Cardiff University, Wales, UK.
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Aydinuraz K, Ağalar C, Ağalar F, Çeken S, Duruyürek N, Vural T. In Vitro S. epidermidis and S. aureus Adherence to Composite and Lightweight Polypropylene Grafts. J Surg Res 2009; 157:e79-86. [DOI: 10.1016/j.jss.2009.04.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Revised: 02/20/2009] [Accepted: 04/01/2009] [Indexed: 11/16/2022]
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Chew BH, Lange D. Ureteral stent symptoms and associated infections: a biomaterials perspective. Nat Rev Urol 2009; 6:440-8. [PMID: 19597512 DOI: 10.1038/nrurol.2009.124] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ureteral stents are commonly used in the field of urology, and, given their indwelling nature, are often a nidus for infection and a cause of discomfort. To minimize symptoms, the urologic surgeon should first consider whether a stent needs to be placed at all. Softer stents do not seem to improve patient comfort. Stents that are too long, specifically those that cross the midline of the bladder, significantly increase the frequency of stent-related symptoms. Administering alpha blockers while the stent is indwelling can reduce these symptoms. Antibiotic prophylaxis or concomitant antibiotic administration does not seem to reduce the incidence of stent-related urinary tract infection. At present, drug-eluting stents have shown the most promise for inhibiting bacterial adhesion and biofilm formation. Future stent designs that maintain drainage of the kidney and ureter while minimizing inflammation and contact with the urothelium will improve patient outcomes. By better understanding the basic pathways of bacterial adhesion to biomaterials, new stents and medications that target these mechanisms can be developed to eliminate bacterial adhesion and infection in patients with ureteral stents.
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Affiliation(s)
- Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
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15
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Stickler DJ. Bacterial biofilms in patients with indwelling urinary catheters. ACTA ACUST UNITED AC 2008; 5:598-608. [PMID: 18852707 DOI: 10.1038/ncpuro1231] [Citation(s) in RCA: 230] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Accepted: 09/18/2008] [Indexed: 11/09/2022]
Abstract
Bacteria have a basic survival strategy: to colonize surfaces and grow as biofilm communities embedded in a gel-like polysaccharide matrix. The catheterized urinary tract provides ideal conditions for the development of enormous biofilm populations. Many bacterial species colonize indwelling catheters as biofilms, inducing complications in patients' care. The most troublesome complications are the crystalline biofilms that can occlude the catheter lumen and trigger episodes of pyelonephritis and septicemia. The crystalline biofilms result from infection by urease-producing bacteria, particularly Proteus mirabilis. Urease raises the urinary pH and drives the formation of calcium phosphate and magnesium phosphate crystals in the biofilm. All types of catheter are vulnerable to encrustation by these biofilms, and clinical prevention strategies are clearly needed, as bacteria growing in the biofilm mode are resistant to antibiotics. Evidence indicates that treatment of symptomatic, catheter-associated urinary tract infection is more effective if biofilm-laden catheters are changed before antibiotic treatment is initiated. Infection with P. mirabilis exposes the many faults of currently available catheters, and plenty of scope exists for improvement in both their design and production; manufacturers should take up the challenge to improve patient outcomes.
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Affiliation(s)
- David J Stickler
- Cardiff School of Biosciences, Main Building, Cardiff University, Museum Avenue, Cardiff CF103TL, UK.
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Stickler DJ, Lear JC, Morris NS, Macleod SM, Downer A, Cadd DH, Feast WJ. Observations on the adherence of Proteus mirabilis onto polymer surfaces. J Appl Microbiol 2006; 100:1028-33. [PMID: 16630003 DOI: 10.1111/j.1365-2672.2006.02840.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Infection of the catheterized urinary tract with Proteus mirabilis causes blockage of the catheter by crystalline bacterial biofilms. The aim of this work is to identify a surface-coating for catheters that is not vulnerable to colonization by Pr. mirabilis. METHODS AND RESULTS A parallel-plate flow-cell and phase contrast microscopy were used to follow bacterial adhesion onto polymer films. Experiments with a urease-negative mutant of Pr. mirabilis suspended in buffer or urine, identified agarose as a polymer on which biofilm did not form. In tests with wild-type urease-producing cells in urine, no adhesion of cells onto agarose was observed for 3 h but then as the pH rose above 8.2, the surface rapidly became colonized by crystalline biofilm. CONCLUSIONS In urine at pH below 8.0, Pr. mirabilis does not adhere to agarose-coated surfaces. When the pH rises above 8.2, however, aggregates of crystals and bacteria form in the urine and are deposited on such surfaces. SIGNIFICANCE AND IMPACT OF THE STUDY Strategies to prevent the formation of crystalline biofilms on urinary catheters will need to consider both the properties of the surface-coatings and the requirement to prevent the alkaline conditions that induce crystal formation in urine.
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Affiliation(s)
- D J Stickler
- Cardiff School of Biosciences, Cardiff University, Cardiff, Wales, UK.
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