Emerging evidence-based innovative approaches to control catheter-associated urinary tract infection: a review

Mucosal injuries from indwelling catheters: A scoping review

There is currently a lack of clarity concerning the types and frequency of mucosa injuries occurring in urine bladders among patients with indwelling urine catheters that are of modern design and material. The aim of the study was to identify and present the available information regarding mucosa injuries in urine bladders among adult patients with indwelling urine catheters. The research question was: What is known about mucosa injuries in urine bladders among patients with indwelling urine catheters? A scoping review applying the patient, exposure, and outcome framework. A preliminary search was made to identify the keywords, and the selection process followed the Preferred Reporting Items for Systematic Review and Meta-Analysis flow diagram. The final search across five databases retrieved a total of 8,883 records. Eight studies from three countries were included and the studies used two main methods for collecting data. Eleven concepts to describe the injuries were identified, with a range from one to five studies using the same concept. Mucosa injuries, of which polypoid cystitis was most frequently reported, occurred in all studies, and ranged from 41% to 100% per study. The size of injured area varied between 0.5 to 2.5 cm. The posterior wall of the bladder was the most common area where injuries were found. This scoping review sheds light on the limited understanding of mucosal injuries in urine bladders among adult patients with indwelling urinary catheters. Moving forward, concerted efforts are warranted to bridge existing knowledge gaps to enhance our understanding of mucosal injuries and improve clinical outcomes for adult patients with indwelling urinary catheters. The lack of a robust scientific base for the impact of indwelling urine catheters on the urine bladder mucosa warrants future studies.

Biological and Biophysical Methods for Evaluation of Inhibitors of Sortase A in Staphylococcus aureus: An Overview

Staphylococcus aureus, one of the most notorious pathogens, develops antibiotic resistance by the formation of a thick layer of exopolysaccharides known as biofilms. Sortase A, a transpeptidase responsible for biofilm formation and attachment to the host surface, has emerged as an important drug target for development of anti-virulence agents. A number of sortase A inhibitors, both peptide and non-peptides are reported which involved the use of several experiments which may provide insights regarding binding affinity, specificity, safety, and efficacy of ligands. In this review, we focus on the principles, pros and cons, and the type of information obtained from biophysical (FRET assay, Microscale Thermophoresis, Surface Plasmon Resonance, CD spectroscopy etc.) and biological (cell viability assay, biofilm formation assay, CLSM, western blot analysis, in vivo characterization on mice etc.) methods for estimation of probable sortase A inhibitors, which might be helpful to the researchers who might be interested to delve into the development of sortase A inhibitors as a drug, to address the burning question of antimicrobial resistance (AMR).

Single-center, double-blind, randomized, placebo-controlled pilot study of Canoxidin® for prevention of catheter encrustation in patients with indwelling catheters

INTRODUCTION AND OBJECTIVES

Long-term use of an indwelling catheter is associated with complications such as catheter encrustation and infection. Canoxidin® is a novel oral treatment that can potentially prevent catheter encrustation, as it contains a urine acidifier and a combination of two crystallization inhibitors. This study aimed to evaluate the effects of Canoxidin® on catheter encrustation in patients with indwelling Foley catheters.

PATIENTS AND METHODS

This was a single-center, double-blind, randomized, placebo-controlled study. Neuro-urology patients aged ≥18 years with an indwelling catheter (urethral or suprapubic) were randomized to treatment consisting of either Canoxidin® or placebo for one month. Foley catheters (two per patient, one before treatment and one after treatment) were removed for analysis of the presence and degree of encrustation.

RESULTS

A total of 40 patients were enrolled and randomized, 28 of whom had analyzable catheters (13 assigned to Canoxidin® and 15 assigned to placebo). The patients had a mean age of 51.8 years, and eight (28.6%) were female. Two patients (13.3%) in the placebo group and eight patients (61.5%) in the Canoxidin® group experienced an improvement (less encrustation). There was a significant association between Canoxidin® and improvement (odds ratio: 10.4, 95% confidence interval: 1.6 to 66.9, P = 0.016). No adverse effects attributable to the treatment were reported.

CONCLUSIONS

The overall rate of catheter encrustation was high among those with indwelling Foley catheters. One-month treatment with Canoxidin® reduced the formation of these encrustations, with an excellent short-term safety profile.

Potential of silver nanoparticles synthesized from Justicia adhatoda metabolites for inhibiting biofilm on urinary catheters

In the present study, we investigated the anti-biofilm effect of urinary catheters fabricated with biogenic nanoparticles synthesized from metabolites of Justicia adhatoda under in vitro conditions against human pathogenic bacteria. Silver nanoparticles were synthesized in the reaction mixture composed of 2 % w/v of 0.1 M of precursor (silver nitrate) and 0.2 g of the metabolites obtained from ethanolic extract of Justicia adhatoda. Characterization of the nanoparticles was done by UV visible spectroscopy, fourier infrared spectroscopy (FTIR), scanning electron microscopy (SEM) and X ray diffraction (XRD) to confirm the structural and functional properties. Primary conformation of nanoparticles synthesis by UV visible spectroscopy revealed the notable absorption spectra at 425 nm with a wavelength shift around 450 nm, likely due to surface plasmon resonance excitation. SEM analysis showed spherical, monodisperse, nano scale particles with a size range of 50-60 nm. Crystaline phase of the synthesized nanoparticles was confirmed by x ray diffraction studies which showed the distinct peaks at (2θ) 27.90, 32.20, 46.30, 54.40, and 67.40, corresponding to (111), (200), (220), (222), and (311) planes of nano scale silver. The biocompatibility of these nanoparticles was assessed through zebrafish embryonic toxicity study which showed more than 90 % of embryos were alive and healthy. No marked changes on the blood cells also confirmed best hemocompatibility of the nanoparticles. Synthesized nanoparticles thus obtained were fabricated on the urinary catheter and the fabrication was confirmed by FTIR and SEM analysis. Notable changes in the absorption peaks, uniform coating and embedding of silver nanoparticles studied by FTIR and SEM analysis confirmed the fabrication of silver nanoparticles. The coated catheters demonstrated significant antibacterial activity against pathogenic bacterial strains, including E. coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853. Anti-biofilm studies, conducted using a modified microtiter plate crystal violet assay, revealed effective inhibition of both bacterial adhesion and biofilm development. 85 % of biofilm inhibition was recorded against both the tested strains. The coating method presented in this study shows promise for enhancing infection resistance in commonly used medical devices like urinary catheters, thus addressing device-associated infections.

New Antimicrobial Materials Based on Plasticized Polyvinyl Chloride for Urinary Catheters: Preparation and Testing

Given the constant increased number of nosocomial infections in hospitals, especially associated with prolonged usage of inserted medical devices, our work aims to ameliorate clinical experience and promote faster healing of patients undergoing urinary catheterization by improving the properties of medical devices materials. Within this research, nine different composites were prepared based on polyvinyl chloride, using three different plasticizers (di-(2-ethylhexyl) phthalate, Proviplast 2646, and Proviplast 2755), and two different antimicrobial additives containing silver nanoparticles. The prepared materials were analyzed, and their physicochemical properties were determined: water absorption, relative density, plasticizer migration, hydrophobicity/hydrophilicity by contact angle measurement, Shore A hardness, tensile strength, and elongation at break. Structure and morphology were also investigated by means of FTIR, SEM, and EDX analyses, and thermal (TG-DSC) and biological properties were evaluated. The most important aspects of obtained results are showing that plasticizer migration was significantly reduced (to almost zero) and that the usage of antimicrobial additives improved the materials' biocompatibility. Thus, based on the concluded favorable properties, the obtained materials can be further used for catheter development. Pressure-flow studies for different sizes and configurations are the next steps toward advanced in vivo and clinical trials.

Investigation of Chlorhexidine and Chitosan Gel-Based Coatings for the Prevention of Intravascular Catheter-Associated Infections Following Quality by Design Approach

Intravascular catheter-associated infections pose a significant threat to the health of patients because of biofilm formation. Hence, it is imperative to exploit cost-effective approaches to improve patient compliance. With this aim, our present study reported the potential of an antimicrobial polymeric gel coating of chitosan (CS) and chlorhexidine (CHX) on the marketed urinary catheters to minimize the risk of biofilm formation. The study involved the implementation of the Quality by Design (QbD) approach by identifying the critical parameters that can affect the coating of the catheter's surface in any possible way. Later, design of experiments (DoE) analysis affirmed the lack of linearity in the model for the studied responses in a holistic manner. Moreover, in vitro studies were conducted for the evaluation of various parameters followed by the antibiofilm study. The coating exhibited promising release of CHX in the artificial urinary media together with retention of the coating on the catheter's surface. Therefore, this study aims to emphasize the importance of a systematic and quality-focused approach by contributing to the development of a safe, effective, and reliable catheter coating to enhance intravascular catheter safety.

Piezoelectrically-activated antibacterial catheter for prevention of urinary tract infections in an on-demand manner

Catheter-associated urinary tract infection (CAUTI) is a common clinical problem, especially during long-term catheterization, causing additional pain to patients. The development of novel antimicrobial coatings is needed to prolong the service life of catheters and reduce the incidence of CAUTIs. Herein, we designed an antimicrobial catheter coated with a piezoelectric zinc oxide nanoparticles (ZnO NPs)-incorporated polyvinylidene difluoride-hexafluoropropylene (ZnO-PVDF-HFP) membrane. ZnO-PVDF-HFP could be stably coated onto silicone catheters simply by a one-step solution film-forming method, very convenient for industrial production. In vitro, it was demonstrated that ZnO-PVDF-HFP coating could significantly inhibit bacterial growth and the formation of bacterial biofilm under ultrasound-mediated mechanical stimulation even after 4 weeks. Importantly, the on and off of antimicrobial activity as well as the strenth of antibacterial property could be controlled in an adaptive manner via ultrasound. In a rabbit model, the ZnO-PVDF-HFP-coated catheter significantly reduced the incidence CAUTIs compared with clinically-commonly used catheters under assistance of ultrasonication, and no side effect was detected. Collectively, the study provided a novel antibacterial catheter to prevent the occurrence of CAUTIs, whose antibacterial activity could be controlled in on-demand manner, adaptive to infection situation and promising in clinical application.

Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens

Medical devices such as venous catheters (VCs) and urinary catheters (UCs) are widely used in the hospital setting. However, the implantation of these devices is often accompanied by complications. About 60 to 70% of nosocomial infections (NIs) are linked to biofilms. The main complication is the ability of microorganisms to adhere to surfaces and form biofilms which protect them and help them to persist in the host. Indeed, by crossing the skin barrier, the insertion of VC inevitably allows skin flora or accidental environmental contaminants to access the underlying tissues and cause fatal complications like bloodstream infections (BSIs). In fact, 80,000 central venous catheters-BSIs (CVC-BSIs)-mainly occur in intensive care units (ICUs) with a death rate of 12 to 25%. Similarly, catheter-associated urinary tract infections (CA-UTIs) are the most commonlyhospital-acquired infections (HAIs) worldwide.These infections represent up to 40% of NIs.In this review, we present a summary of biofilm formation steps. We provide an overview of two main and important infections in clinical settings linked to medical devices, namely the catheter-asociated bloodstream infections (CA-BSIs) and catheter-associated urinary tract infections (CA-UTIs), and highlight also the most multidrug resistant bacteria implicated in these infections. Furthermore, we draw attention toseveral useful prevention strategies, and advanced antimicrobial and antifouling approaches developed to reduce bacterial colonization on catheter surfaces and the incidence of the catheter-related infections.

Effective elimination of bacteria on hard surfaces by the combined use of bacteriophages and chemical disinfectants

Hospital-acquired infections (HAIs) represent one of the significant causes of morbidity and mortality worldwide, and controlling pathogens in the hospital environment is of great importance. Currently, the standard disinfection method in the hospital environment is chemical disinfection. However, disinfectants are usually not used strictly according to the label, making them less effective in disinfection. Therefore, there is an emergent need to find a better approach that can be used in hospitals to control pathogenic bacteria in the clinical environment. Bacteriophages (phages) are effective in killing bacteria and have been applied in the treatment of bacterial infections but have not received enough attention regarding the control of contamination in the clinical environment. In this study, we found that various phages remain active in the presence of chemical disinfectants. Moreover, the combined use of specific phages and chemical disinfectants is more effective in removing bacterial biofilms and eliminating bacteria on hard surfaces. Thus, this proof-of-concept study indicates that adding phages directly to chemical disinfectants might be an effective and economical approach to enhance clinical environment disinfection.

IMPORTANCE

In this study, we investigated whether the combination of bacteriophages and chemical disinfectants can enhance the efficacy of reducing bacterial contamination on hard surfaces in the clinical setting. We found that specific phages are active in chemical disinfectants and that the combined use of phages and chemical disinfectants was highly effective in reducing bacterial presence on hard surfaces. As a proof-of-concept, we demonstrated that adding specific phages directly to chemical disinfectants is an effective and cost-efficient strategy for clinical environment disinfection.

Resveratrol-Encapsulated Glutathione-Modified Robust Mesoporous Silica Nanoparticles as an Antibacterial and Antibiofilm Coating Agent for Medical Devices

The emergence of various lethal bacterial infections and their adherence to medical devices are major public health concerns. The increased bacterial exposure and titer are accompanied by the inappropriate use of antibiotics that sometimes lead to antibiotic resistance, and therefore, a drug-free antibacterial approach is required. Several nanoparticles (NPs) have been developed as antibacterial and antibiofilm coating agents, which can overcome different drug resistance mechanisms by inhibiting the important processes related to bacterial virulence potential. However, developing safe and biocompatible nanomaterials (NMs) for these applications has remained a major challenge due to their poorly understood mechanism of action. In this work, biogenic silica NPs were modified with glutathione (GSH) to form GSH@SNP (∼80 ± 15 nm) for targeting the bacterial cell surface and biofilm. GSH@SNP was loaded with resveratrol to obtain Res_GSH@SNP (∼124 ± 15 nm) that enhances the antibacterial activity of the NPs against Staphylococcus aureus and Escherichia coli by ∼51 and ∼49%, respectively, compared to GSH@SNP. Res_GSH@SNP is responsible for binding to the bacterial cell surface receptors that interrupt the cell membrane potential, leading to reactive oxygen species (ROS) generation, membrane disruption, and DNA damage and eventually resulting in antibacterial activity. Moreover, the antibiofilm activity of Res_GSH@SNP has been found to result from the interaction of the NPs with the abundant carbohydrates present on the biofilm surface. To check the practical utility of Res_GSH@SNP, these were further evaluated as an antibacterial and antibiofilm coating agent for urinary catheters and were found to be effective even after multiple washes. Res_GSH@SNP has been found to exhibit ∼80 ± 1.4% cytocompatibility toward fibroblast NIH-3T3 cells. Overall, this study is expected to pave the way for the development of biocompatible NP-based coating agents for medical devices.

Exploring nanocomposites for controlling infectious microorganisms: charting the path forward in antimicrobial strategies

Nanocomposites, formed by combining a matrix (commonly polymer or ceramic) with nanofillers (nano-sized inclusions like nanoparticles or nanofibers), possess distinct attributes attributed to their composition. Their unique physicochemical properties and interaction capabilities with microbial cells position them as a promising avenue for infectious disease treatment. The escalating prevalence of multi-drug resistant bacteria intensifies the need for alternative solutions. Traditional approaches involve antimicrobial agents like antibiotics, antivirals, and antifungals, targeting specific microbial aspects. This review presents a comprehensive overview of diverse nanocomposite types and highlights the potential of tailored matrix and antibacterial agent selection within nanocomposites to enhance treatment efficacy and decrease antibiotic resistance risks. Challenges such as toxicity, safety, and scalability in clinical applications are also acknowledged. Ultimately, the convergence of nanotechnology and infectious disease research offers the prospect of enhanced therapeutic strategies, envisioning a future wherein advanced materials revolutionize the landscape of medical treatment.