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Beysens M, Tailly TO. Ureteral stents in urolithiasis. Asian J Urol 2018; 5:274-286. [PMID: 30364608 PMCID: PMC6197553 DOI: 10.1016/j.ajur.2018.07.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/29/2018] [Accepted: 05/25/2018] [Indexed: 02/08/2023] Open
Abstract
Ever since the ureteral stent design was fitted with a curl on both sides to prevent it from migrating up or down the ureter some 40 years ago, its use has gained tremendous momentum, aiding in the rise and evolution of endourology and has confidently kept its place in modern time urology. Over the past four decades, several designs, coating and biomaterials have been developed, trying to reduce infection, encrustation and other stent related symptoms. As the ideal stent has not yet been discovered, different ways of helping patients with their complaints have been researched. This review will cover these aspects of stent use in urolithiasis.
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Affiliation(s)
| | - Thomas O. Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
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52
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Milo S, Nzakizwanayo J, Hathaway HJ, Jones BV, Jenkins ATA. Emerging medical and engineering strategies for the prevention of long-term indwelling catheter blockage. Proc Inst Mech Eng H 2018; 233:68-83. [PMID: 29807465 DOI: 10.1177/0954411918776691] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Urinary catheters have been used on an intermittent or indwelling basis for centuries, in order to relieve urinary retention and incontinence. Nevertheless, the use of urinary catheters in the clinical setting is fraught with complication, the most common of which is the development of nosocomial urinary tract infections, known as catheter-associated urinary tract infections. Infections of this nature are not only significant owing to their high incidence rate and subsequent economic burden but also to the severe medical consecutions that result. A range of techniques have been employed in recent years, utilising various technologies in attempts to counteract the perilous medical cascade following catheter blockage. This review will focus on the current advancement (within the last 10 years) in prevention of encrustation and blockage of long-term indwelling catheters both from engineering and medical perspectives, with particular emphasis on the importance of stimuli-responsive systems.
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Affiliation(s)
- Scarlet Milo
- 1 Department of Chemistry, University of Bath, Bath, UK
| | - Jonathan Nzakizwanayo
- 2 School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | | | - Brian V Jones
- 4 Department of Biology and Biochemistry, University of Bath, UK
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53
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Porin self-association enables cell-to-cell contact in Providencia stuartii floating communities. Proc Natl Acad Sci U S A 2018; 115:E2220-E2228. [PMID: 29476011 DOI: 10.1073/pnas.1714582115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The gram-negative pathogen Providencia stuartii forms floating communities within which adjacent cells are in apparent contact, before depositing as canonical surface-attached biofilms. Because porins are the most abundant proteins in the outer membrane of gram-negative bacteria, we hypothesized that they could be involved in cell-to-cell contact and undertook a structure-function relationship study on the two porins of P. stuartii, Omp-Pst1 and Omp-Pst2. Our crystal structures reveal that these porins can self-associate through their extracellular loops, forming dimers of trimers (DOTs) that could enable cell-to-cell contact within floating communities. Support for this hypothesis was obtained by studying the porin-dependent aggregation of liposomes and model cells. The observation that facing channels are open in the two porin structures suggests that DOTs could not only promote cell-to-cell contact but also contribute to intercellular communication.
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54
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Gerber D, Forster CS, Hsieh M. The Role of the Genitourinary Microbiome in Pediatric Urology: a Review. Curr Urol Rep 2018; 19:13. [PMID: 29468401 DOI: 10.1007/s11934-018-0763-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW In this review, we highlight the effects of the microbiome on urologic diseases that affect the pediatric patient. RECENT FINDINGS Perturbations in the urinary microbiome have been shown to be associated with a number of urologic diseases affecting children, namely urinary tract infection, overactive bladder/urge urinary incontinence, and urolithiasis. Recently, improved cultivation and sequencing technologies have allowed for the discovery of a significant and diverse microbiome in the bladder, previously assumed to be sterile. Early studies aimed to identify the resident bacterial species and demonstrate the efficacy of sequencing and enhanced quantitative urine culture. More recently, research has sought to elucidate the association between the microbiome and urologic disease, as well as to demonstrate effects of manipulation of the microbiome on various urologic pathologies. With an improved appreciation for the impact of the urinary microbiome on urologic disease, researchers have begun to explore the impact of these resident bacteria in pediatric urology.
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Affiliation(s)
- Daniel Gerber
- Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, 20007, USA
| | - Catherine S Forster
- Children's National Health System, 111 Michigan Avenue NW Suite M4800, Washington, DC, 20010, USA.,Biomedical Research Institute, 9410 Key West Avenue, Rockville, MD, 20850, USA
| | - Michael Hsieh
- Children's National Health System, 111 Michigan Avenue NW Suite M4800, Washington, DC, 20010, USA. .,Biomedical Research Institute, 9410 Key West Avenue, Rockville, MD, 20850, USA.
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55
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Evaluation of Biofilm Induced Urinary Infection Stone Formation in a Novel Laboratory Model System. J Urol 2018; 199:178-185. [DOI: 10.1016/j.juro.2017.08.083] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 11/23/2022]
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56
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El Khatib M, Tran QT, Nasrallah C, Lopes J, Bolla JM, Vivaudou M, Pagès JM, Colletier JP. Providencia stuartii form biofilms and floating communities of cells that display high resistance to environmental insults. PLoS One 2017; 12:e0174213. [PMID: 28334028 PMCID: PMC5363852 DOI: 10.1371/journal.pone.0174213] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/06/2017] [Indexed: 12/21/2022] Open
Abstract
Biofilms are organized communities of bacterial cells that are responsible for the majority of human chronic bacterial infections. Providencia stuartii is a Gram-negative biofilm-forming bacterium involved in high incidence of urinary tract infections in catheterized patients. Yet, the structuration of these biofilms, and their resistance to environmental insults remain poorly understood. Here, we report on planktonic cell growth and biofilm formation by P. stuartii, in conditions that mimic its most common pathophysiological habitat in humans, i.e. the urinary tract. We observed that, in the planktonic state, P. stuartii forms floating communities of cells, prior to attachment to a surface and subsequent adoption of the biofilm phenotype. P. stuartii planktonic and biofilm cells are remarkably resistant to calcium, magnesium and to high concentrations of urea, and show the ability to grow over a wide range of pHs. Experiments conducted on a P. stuartii strain knocked-out for the Omp-Pst2 porin sheds light on the role it plays in the early stages of growth, as well as in the adaptation to high concentration of urea and to varying pH.
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Affiliation(s)
- Mariam El Khatib
- Institut de Biologie Structurale, Université Grenoble Alpes – Commissariat à l’Énergie Atomique – Centre National de la Recherche Scientifique, Grenoble, France
| | - Que-Tien Tran
- School of Biophysics, Jacobs University of Bremen, Bremen, Germany
| | - Chady Nasrallah
- Institut de Biologie Structurale, Université Grenoble Alpes – Commissariat à l’Énergie Atomique – Centre National de la Recherche Scientifique, Grenoble, France
| | - Julie Lopes
- Institut de Biologie Structurale, Université Grenoble Alpes – Commissariat à l’Énergie Atomique – Centre National de la Recherche Scientifique, Grenoble, France
| | - Jean-Michel Bolla
- Équipe Transporteurs Membranaires, Chimiorésistance et Drug-Design, Université Aix-Marseille – Institut de Recherche Biomédicale des Armées, Marseille, France
| | - Michel Vivaudou
- Institut de Biologie Structurale, Université Grenoble Alpes – Commissariat à l’Énergie Atomique – Centre National de la Recherche Scientifique, Grenoble, France
| | - Jean-Marie Pagès
- Équipe Transporteurs Membranaires, Chimiorésistance et Drug-Design, Université Aix-Marseille – Institut de Recherche Biomédicale des Armées, Marseille, France
| | - Jacques-Philippe Colletier
- Institut de Biologie Structurale, Université Grenoble Alpes – Commissariat à l’Énergie Atomique – Centre National de la Recherche Scientifique, Grenoble, France
- * E-mail:
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57
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Singha P, Locklin J, Handa H. A review of the recent advances in antimicrobial coatings for urinary catheters. Acta Biomater 2017; 50:20-40. [PMID: 27916738 PMCID: PMC5316300 DOI: 10.1016/j.actbio.2016.11.070] [Citation(s) in RCA: 242] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 12/21/2022]
Abstract
More than 75% of hospital-acquired or nosocomial urinary tract infections are initiated by urinary catheters, which are used during the treatment of 15-25% of hospitalized patients. Among other purposes, urinary catheters are primarily used for draining urine after surgeries and for urinary incontinence. During catheter-associated urinary tract infections, bacteria travel up to the bladder and cause infection. A major cause of catheter-associated urinary tract infection is attributed to the use of non-ideal materials in the fabrication of urinary catheters. Such materials allow for the colonization of microorganisms, leading to bacteriuria and infection, depending on the severity of symptoms. The ideal urinary catheter is made out of materials that are biocompatible, antimicrobial, and antifouling. Although an abundance of research has been conducted over the last forty-five years on the subject, the ideal biomaterial, especially for long-term catheterization of more than a month, has yet to be developed. The aim of this review is to highlight the recent advances (over the past 10years) in developing antimicrobial materials for urinary catheters and to outline future requirements and prospects that guide catheter materials selection and design. STATEMENT OF SIGNIFICANCE This review article intends to provide an expansive insight into the various antimicrobial agents currently being researched for urinary catheter coatings. According to CDC, approximately 75% of urinary tract infections are caused by urinary catheters and 15-25% of hospitalized patients undergo catheterization. In addition to these alarming statistics, the increasing cost and health related complications associated with catheter associated UTIs make the research for antimicrobial urinary catheter coatings even more pertinent. This review provides a comprehensive summary of the history, the latest progress in development of the coatings and a brief conjecture on what the future entails for each of the antimicrobial agents discussed.
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Affiliation(s)
- Priyadarshini Singha
- School of Materials, Chemical and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| | - Jason Locklin
- School of Materials, Chemical and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA; Department of Chemistry, University of Georgia, Athens, GA, USA.
| | - Hitesh Handa
- School of Materials, Chemical and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA.
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58
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Gultekinoglu M, Kurum B, Karahan S, Kart D, Sagiroglu M, Ertaş N, Haluk Ozen A, Ulubayram K. Polyethyleneimine brushes effectively inhibit encrustation on polyurethane ureteral stents both in dynamic bioreactor and in vivo. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 71:1166-1174. [DOI: 10.1016/j.msec.2016.11.125] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/27/2016] [Indexed: 11/15/2022]
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59
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The Pathogenic Potential of Proteus mirabilis Is Enhanced by Other Uropathogens during Polymicrobial Urinary Tract Infection. Infect Immun 2017; 85:IAI.00808-16. [PMID: 27895127 DOI: 10.1128/iai.00808-16] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/20/2016] [Indexed: 11/20/2022] Open
Abstract
Urinary catheter use is prevalent in health care settings, and polymicrobial colonization by urease-positive organisms, such as Proteus mirabilis and Providencia stuartii, commonly occurs with long-term catheterization. We previously demonstrated that coinfection with P. mirabilis and P. stuartii increased overall urease activity in vitro and disease severity in a model of urinary tract infection (UTI). In this study, we expanded these findings to a murine model of catheter-associated UTI (CAUTI), delineated the contribution of enhanced urease activity to coinfection pathogenesis, and screened for enhanced urease activity with other common CAUTI pathogens. In the UTI model, mice coinfected with the two species exhibited higher urine pH values, urolithiasis, bacteremia, and more pronounced tissue damage and inflammation compared to the findings for mice infected with a single species, despite having a similar bacterial burden within the urinary tract. The presence of P. stuartii, regardless of urease production by this organism, was sufficient to enhance P. mirabilis urease activity and increase disease severity, and enhanced urease activity was the predominant factor driving tissue damage and the dissemination of both organisms to the bloodstream during coinfection. These findings were largely recapitulated in the CAUTI model. Other uropathogens also enhanced P. mirabilis urease activity in vitro, including recent clinical isolates of Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae, and Pseudomonas aeruginosa We therefore conclude that the underlying mechanism of enhanced urease activity may represent a widespread target for limiting the detrimental consequences of polymicrobial catheter colonization, particularly by P. mirabilis and other urease-positive bacteria.
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60
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Bird VY, Chastain-Gross R, Sutkowski R, Bird VG, Vyas P, Joseph R. Pseudomonas aeruginosa as an Etiologic Agent of Nephrolithiasis in Deep Water Divers. J Endourol Case Rep 2017; 3:4-6. [PMID: 28164160 PMCID: PMC5248537 DOI: 10.1089/cren.2016.0117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: A number of occupations and professions may be associated with unique hazards relevant to urologic care. Case Presentation: We relate the presentation, care, and the occupational hazard of urinary tract infection (UTI), presenting as cystitis and pyelonephritis, with stone formation in a scuba diver. The patient voiced concern that his diving suit malfunction was related to his UTI and stone disease. We review the risk of UTI in the diving environment. We also report the development of infection-related stone in this case. Our evaluation included consultation with an expert in diving and associated equipment. Conclusion: Careful installation of P-valves in dry suits, proper maintenance, and monitoring for leakage improved post-dive hygiene, and proper maintenance of P-valve tubing and diving equipment may decrease the incidence of these complications described. Urologists treating UTI and stone disease should be aware of this occupation-related hazard.
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Affiliation(s)
- Victoria Y Bird
- Department of Urology, University of Florida , Gainesville, Florida
| | | | - Raymond Sutkowski
- Department of Radiology, University of Florida , Gainesville, Florida
| | - Vincent G Bird
- Department of Urology, University of Florida , Gainesville, Florida
| | - Paulas Vyas
- Department of Urology, University of Florida , Gainesville, Florida
| | - Ryan Joseph
- Department of Biology, College of Liberal Arts and Sciences, University of Florida , Gainesville, Florida
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61
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Azevedo AS, Almeida C, Melo LF, Azevedo NF. Impact of polymicrobial biofilms in catheter-associated urinary tract infections. Crit Rev Microbiol 2016; 43:423-439. [PMID: 28033847 DOI: 10.1080/1040841x.2016.1240656] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Recent reports have demonstrated that most biofilms involved in catheter-associated urinary tract infections are polymicrobial communities, with pathogenic microorganisms (e.g. Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae) and uncommon microorganisms (e.g. Delftia tsuruhatensis, Achromobacter xylosoxidans) frequently co-inhabiting the same urinary catheter. However, little is known about the interactions that occur between different microorganisms and how they impact biofilm formation and infection outcome. This lack of knowledge affects CAUTIs management as uncommon bacteria action can, for instance, influence the rate at which pathogens adhere and grow, as well as affect the overall biofilm resistance to antibiotics. Another relevant aspect is the understanding of factors that drive a single pathogenic bacterium to become prevalent in a polymicrobial community and subsequently cause infection. In this review, a general overview about the IMDs-associated biofilm infections is provided, with an emphasis on the pathophysiology and the microbiome composition of CAUTIs. Based on the available literature, it is clear that more research about the microbiome interaction, mechanisms of biofilm formation and of antimicrobial tolerance of the polymicrobial consortium are required to better understand and treat these infections.
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Affiliation(s)
- Andreia S Azevedo
- a Department of Chemical Engineering, Faculty of Engineering , Laboratory for Process Engineering, Environment, and Energy and Biotechnology Engineering (LEPABE), University of Porto , Porto , Portugal
| | - Carina Almeida
- a Department of Chemical Engineering, Faculty of Engineering , Laboratory for Process Engineering, Environment, and Energy and Biotechnology Engineering (LEPABE), University of Porto , Porto , Portugal.,b Institute for Biotechnology and Bioengineering (IBB), Centre of Biological Engineering, Universidade do Minho , Braga , Portugal
| | - Luís F Melo
- a Department of Chemical Engineering, Faculty of Engineering , Laboratory for Process Engineering, Environment, and Energy and Biotechnology Engineering (LEPABE), University of Porto , Porto , Portugal
| | - Nuno F Azevedo
- a Department of Chemical Engineering, Faculty of Engineering , Laboratory for Process Engineering, Environment, and Energy and Biotechnology Engineering (LEPABE), University of Porto , Porto , Portugal
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62
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Norsworthy AN, Pearson MM. From Catheter to Kidney Stone: The Uropathogenic Lifestyle of Proteus mirabilis. Trends Microbiol 2016; 25:304-315. [PMID: 28017513 DOI: 10.1016/j.tim.2016.11.015] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/17/2016] [Accepted: 11/28/2016] [Indexed: 12/15/2022]
Abstract
Proteus mirabilis is a model organism for urease-producing uropathogens. These diverse bacteria cause infection stones in the urinary tract and form crystalline biofilms on indwelling urinary catheters, frequently leading to polymicrobial infection. Recent work has elucidated how P. mirabilis causes all of these disease states. Particularly exciting is the discovery that this bacterium forms large clusters in the bladder lumen that are sites for stone formation. These clusters, and other steps of infection, require two virulence factors in particular: urease and MR/P fimbriae. Highlighting the importance of MR/P fimbriae is the cotranscribed regulator, MrpJ, which globally controls virulence. Overall, P. mirabilis exhibits an extraordinary lifestyle, and further probing will answer exciting basic microbiological and clinically relevant questions.
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Affiliation(s)
- Allison N Norsworthy
- Department of Microbiology, New York University Medical Center, New York, NY, USA
| | - Melanie M Pearson
- Department of Microbiology, New York University Medical Center, New York, NY, USA; Department of Urology, New York University Medical Center, New York, NY, USA; Current address: University of Michigan Medical School, Department of Microbiology and Immunology, 5641 Medical Science Building II, 1150 West Medical Center Dr., Ann Arbor, MI 48109-0620, USA.
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63
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Abstract
Strains of Klebsiella pneumoniae are frequently opportunistic pathogens implicated in urinary tract and catheter-associated urinary-tract infections of hospitalized patients and compromised individuals. Infections are particularly difficult to treat since most clinical isolates exhibit resistance to several antibiotics leading to treatment failure and the possibility of systemic dissemination. Infections of medical devices such as urinary catheters is a major site of K. pneumoniae infections and has been suggested to involve the formation of biofilms on these surfaces. Over the last decade there has been an increase in research activity designed to investigate the pathogenesis of K. pneumoniae in the urinary tract. These investigations have begun to define the bacterial factors that contribute to growth and biofilm formation. Several virulence factors have been demonstrated to mediate K. pneumoniae infectivity and include, but are most likely not limited to, adherence factors, capsule production, lipopolysaccharide presence, and siderophore activity. The development of both in vitro and in vivo models of infection will lead to further elucidation of the molecular pathogenesis of K. pneumoniae. As for most opportunistic infections, the role of host factors as well as bacterial traits are crucial in determining the outcome of infections. In addition, multidrug-resistant strains of these bacteria have become a serious problem in the treatment of Klebsiella infections and novel strategies to prevent and inhibit bacterial growth need to be developed. Overall, the frequency, significance, and morbidity associated with K. pneumoniae urinary tract infections have increased over many years. The emergence of these bacteria as sources of antibiotic resistance and pathogens of the urinary tract present a challenging problem for the clinician in terms of management and treatment of individuals.
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64
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Li X, Lu N, Brady HR, Packman AI. Biomineralization strongly modulates the formation ofProteus mirabilisandPseudomonas aeruginosadual-species biofilms. FEMS Microbiol Ecol 2016; 92:fiw189. [DOI: 10.1093/femsec/fiw189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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65
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Melo LDR, Veiga P, Cerca N, Kropinski AM, Almeida C, Azeredo J, Sillankorva S. Development of a Phage Cocktail to Control Proteus mirabilis Catheter-associated Urinary Tract Infections. Front Microbiol 2016; 7:1024. [PMID: 27446059 PMCID: PMC4923195 DOI: 10.3389/fmicb.2016.01024] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/16/2016] [Indexed: 11/13/2022] Open
Abstract
Proteus mirabilis is an enterobacterium that causes catheter-associated urinary tract infections (CAUTIs) due to its ability to colonize and form crystalline biofilms on the catheters surface. CAUTIs are very difficult to treat, since biofilm structures are highly tolerant to antibiotics. Phages have been used widely to control a diversity of bacterial species, however, a limited number of phages for P. mirabilis have been isolated and studied. Here we report the isolation of two novel virulent phages, the podovirus vB_PmiP_5460 and the myovirus vB_PmiM_5461, which are able to target, respectively, 16 of the 26 and all the Proteus strains tested in this study. Both phages have been characterized thoroughly and sequencing data revealed no traces of genes associated with lysogeny. To further evaluate the phages’ ability to prevent catheter’s colonization by Proteus, the phages adherence to silicone surfaces was assessed. Further tests in phage-coated catheters using a dynamic biofilm model simulating CAUTIs, have shown a significant reduction of P. mirabilis biofilm formation up to 168 h of catheterization. These results highlight the potential usefulness of the two isolated phages for the prevention of surface colonization by this bacterium.
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Affiliation(s)
- Luís D R Melo
- Laboratório de Investigação em Biofilmes Rosário Oliveira, Centre of Biological Engineering, University of Minho Braga Braga, Portugal
| | - Patrícia Veiga
- Laboratório de Investigação em Biofilmes Rosário Oliveira, Centre of Biological Engineering, University of Minho Braga Braga, Portugal
| | - Nuno Cerca
- Laboratório de Investigação em Biofilmes Rosário Oliveira, Centre of Biological Engineering, University of Minho Braga Braga, Portugal
| | - Andrew M Kropinski
- Departments of Food Science, Molecular and Cellular Biology, and Pathobiology, University of Guelph, Guelph ON, Canada
| | - Carina Almeida
- Laboratório de Investigação em Biofilmes Rosário Oliveira, Centre of Biological Engineering, University of Minho Braga Braga, Portugal
| | - Joana Azeredo
- Laboratório de Investigação em Biofilmes Rosário Oliveira, Centre of Biological Engineering, University of Minho Braga Braga, Portugal
| | - Sanna Sillankorva
- Laboratório de Investigação em Biofilmes Rosário Oliveira, Centre of Biological Engineering, University of Minho Braga Braga, Portugal
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66
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O'May C, Amzallag O, Bechir K, Tufenkji N. Cranberry derivatives enhance biofilm formation and transiently impair swarming motility of the uropathogen Proteus mirabilis HI4320. Can J Microbiol 2016; 62:464-74. [PMID: 27090825 DOI: 10.1139/cjm-2015-0715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Proteus mirabilis is a major cause of catheter-associated urinary tract infection (CAUTI), emphasizing that novel strategies for targeting this bacterium are needed. Potential targets are P. mirabilis surface-associated swarming motility and the propensity of these bacteria to form biofilms that may lead to catheter blockage. We previously showed that the addition of cranberry powder (CP) to lysogeny broth (LB) medium resulted in impaired P. mirabilis swarming motility over short time periods (up to 16 h). Herein, we significantly expanded on those findings by exploring (i) the effects of cranberry derivatives on biofilm formation of P. mirabilis, (ii) whether swarming inhibition occurred transiently or over longer periods more relevant to real infections (∼3 days), (iii) whether swarming was also blocked by commercially available cranberry juices, (iv) whether CP or cranberry juices exhibited effects under natural urine conditions, and (v) the effects of cranberry on medium pH, which is an indirect indicator of urease activity. At short time scales (24 h), CP and commercially available pure cranberry juice impaired swarming motility and repelled actively swarming bacteria in LB medium. Over longer time periods more representative of infections (∼3 days), the capacity of the cranberry material to impair swarming diminished and bacteria would start to migrate across the surface, albeit by exhibiting a different motility phenotype to the regular "bull's-eye" swarming phenotype of P. mirabilis. This bacterium did not swarm on urine agar or LB agar supplemented with urea, suggesting that any potential application of anti-swarming compounds may be better suited to settings external to the urine environment. Anti-swarming effects were confounded by the ability of cranberry products to enhance biofilm formation in both LB and urine conditions. These findings provide key insights into the long-term strategy of targeting P. mirabilis CAUTIs.
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Affiliation(s)
- Che O'May
- Department of Chemical Engineering, McGill University, 3610 University Street, Montréal, QC H3A 0C5, Canada.,Department of Chemical Engineering, McGill University, 3610 University Street, Montréal, QC H3A 0C5, Canada
| | - Olivier Amzallag
- Department of Chemical Engineering, McGill University, 3610 University Street, Montréal, QC H3A 0C5, Canada.,Department of Chemical Engineering, McGill University, 3610 University Street, Montréal, QC H3A 0C5, Canada
| | - Karim Bechir
- Department of Chemical Engineering, McGill University, 3610 University Street, Montréal, QC H3A 0C5, Canada.,Department of Chemical Engineering, McGill University, 3610 University Street, Montréal, QC H3A 0C5, Canada
| | - Nathalie Tufenkji
- Department of Chemical Engineering, McGill University, 3610 University Street, Montréal, QC H3A 0C5, Canada.,Department of Chemical Engineering, McGill University, 3610 University Street, Montréal, QC H3A 0C5, Canada
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67
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Oppenheimer-Shaanan Y, Sibony-Nevo O, Bloom-Ackermann Z, Suissa R, Steinberg N, Kartvelishvily E, Brumfeld V, Kolodkin-Gal I. Spatio-temporal assembly of functional mineral scaffolds within microbial biofilms. NPJ Biofilms Microbiomes 2016; 2:15031. [PMID: 28721240 PMCID: PMC5515261 DOI: 10.1038/npjbiofilms.2015.31] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 10/22/2015] [Accepted: 12/15/2015] [Indexed: 11/08/2022] Open
Abstract
Historically, multicellular bacterial communities, known as biofilms, have been thought to be held together solely by a self-produced extracellular matrix. Our study identified a novel mechanism maintaining Bacillus subtilis and Mycobacterium smegmatis biofilms-active production of calcite minerals. We studied, for the first time, the effects of mutants defective in biomineralization and calcite formation on biofilm development, resilience and morphology. We demonstrated that an intrinsic rise in carbon dioxide levels within the biofilm is a strong trigger for the initiation of calcite-dependent patterning. The calcite-dependent patterns provide resistance to environmental insults and increase the overall fitness of the microbial community. Our results suggest that it is highly feasible that the formation of mineral scaffolds plays a cardinal and conserved role in bacterial multicellularity.
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Affiliation(s)
| | - Odelia Sibony-Nevo
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | | | - Ronit Suissa
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Nitai Steinberg
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Elena Kartvelishvily
- Department of Chemical Research Support, Chemical Research Support, Weizmann Institute of Science, Rehovot, Israel
| | - Vlad Brumfeld
- Department of Chemical Research Support, Chemical Research Support, Weizmann Institute of Science, Rehovot, Israel
| | - Ilana Kolodkin-Gal
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
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68
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Younis KM, Usup G, Ahmad A. Secondary metabolites produced by marine streptomyces as antibiofilm and quorum-sensing inhibitor of uropathogen Proteus mirabilis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2016; 23:4756-4767. [PMID: 26538254 DOI: 10.1007/s11356-015-5687-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/22/2015] [Indexed: 06/05/2023]
Abstract
Quorum-sensing regulates bacterial biofilm formation and virulence factors, thereby making it an interesting target for attenuating pathogens. In this study, we investigated anti-biofilm and anti-quorum-sensing compounds from secondary metabolites of halophiles marine streptomyces against urinary catheter biofilm forming Proteus mirabilis without effect on growth viability. A total of 40 actinomycetes were isolated from samples collected from different places in Iraq including marine sediments and soil samples. Fifteen isolates identified as streptomyces and their supernatant screened as anti-quorum-sensing by inhibiting quorum-sensing regulated prodigiosin biosynthesis of Serratia marcescens strain Smj-11 as a reporter strain. Isolate Sediment Lake Iraq (sdLi) showed potential anti-quorum-sensing activity. Out of 35 clinical isolates obtained from Urinary catheter used by patient at the Universiti Kebangsaan Malaysia Medical Center, 22 isolates were characterized and identified as Proteus mirabilis. Isolate Urinary Catheter B4 (UCB4) showed the highest biofilm formation with highest resistance to used antibiotic and was chosen for further studies. Ethyl acetate secondary metabolites extract was produced from sdLi isolate. First, we determined the Minimum Inhibitory Concentration (MIC) of sdLi crude extract against UCB4 isolate, and all further experiments used concentrations below the MIC. Tests of subinhibitory concentrations of sdLi crude extract showed good inhibition against UCB4 isolate biofilm formation on urinary catheter and cover glass using Scanning electron microscopy and light microscopy respectively. The influence of sub-MIC of sdLi crude extract was also found to attenuate the quorum sensing (QS)-dependent factors such as hemolysin activity, urease activity, pH value, and motility of UCB4 isolate. Evidence is presented that these nontoxic secondary metabolites may act as antagonists of bacterial quorum sensing by competing with quorum-sensing signals for receptor binding.
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Affiliation(s)
- Khansa Mohammed Younis
- School of Biosciences and Biotechnology, Faculty of Science and Technology, University Kebangsaan Malaysia (UKM), 43600 UKM Bangi, Selangor, Malaysia.
- Department of Biology/Microbiology, Faculty of Sciences, Mosul University, Mosul, Iraq.
| | - Gires Usup
- School of Environmental and Natural Resources Sciences, Faculty of Science and Technology, University Kebangsaan Malaysia (UKM), 43600 UKM Bangi, Selangor, Malaysia.
| | - Asmat Ahmad
- School of Biosciences and Biotechnology, Faculty of Science and Technology, University Kebangsaan Malaysia (UKM), 43600 UKM Bangi, Selangor, Malaysia.
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69
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Milo S, Thet NT, Liu D, Nzakizwanayo J, Jones BV, Jenkins ATA. An in-situ infection detection sensor coating for urinary catheters. Biosens Bioelectron 2016; 81:166-172. [PMID: 26945183 PMCID: PMC4833687 DOI: 10.1016/j.bios.2016.02.059] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 01/23/2023]
Abstract
We describe a novel infection-responsive coating for urinary catheters that provides a clear visual early warning of Proteus mirabilis infection and subsequent blockage. The crystalline biofilms of P. mirabilis can cause serious complications for patients undergoing long-term bladder catheterisation. Healthy urine is around pH 6, bacterial urease increases urine pH leading to the precipitation of calcium and magnesium deposits from the urine, resulting in dense crystalline biofilms on the catheter surface that blocks urine flow. The coating is a dual layered system in which the lower poly(vinyl alcohol) layer contains the self-quenching dye carboxyfluorescein. This is capped by an upper layer of the pH responsive polymer poly(methyl methacrylate-co-methacrylic acid) (Eudragit S100®). Elevation of urinary pH (>pH 7) dissolves the Eudragit layer, releasing the dye to provide a clear visual warning of impending blockage. Evaluation of prototype coatings using a clinically relevant in vitro bladder model system demonstrated that coatings provide up to 12 h advanced warning of blockage, and are stable both in the absence of infection, and in the presence of species that do not cause catheter blockage. At the present time, there are no effective methods to control these infections or provide warning of impending catheter blockage. Development of a dual-layered diagnostic coating sensor for urinary catheter. Provides advance warning of infection by P. mirabilis in response to alkaline urine. Read out via release of carboxyfluorescein dye from coating into urine leg bag. Catheter prototypes ‘report’ infection 12 h before blockage by P. mirablis.
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Affiliation(s)
- Scarlet Milo
- Department of Chemistry, University of Bath, Bath BA2 7AY, UK
| | - Naing Tun Thet
- Department of Chemistry, University of Bath, Bath BA2 7AY, UK
| | - Dan Liu
- Department of Chemistry, University of Bath, Bath BA2 7AY, UK
| | | | - Brian V Jones
- School of Pharmacy and Biomolecular Sciences, University of Brighton, BN2 4GJ, UK; Queen Victoria Hospital NHS Foundation Trust, East Grinstead RH19 3DZ, UK
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70
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Electrochemically active biofilm and photoelectrocatalytic regeneration of the titanium dioxide composite electrode for advanced oxidation in water treatment. Electrochim Acta 2015. [DOI: 10.1016/j.electacta.2015.09.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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71
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Wilks SA, Fader MJ, Keevil CW. Novel Insights into the Proteus mirabilis Crystalline Biofilm Using Real-Time Imaging. PLoS One 2015; 10:e0141711. [PMID: 26516766 PMCID: PMC4627822 DOI: 10.1371/journal.pone.0141711] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 10/12/2015] [Indexed: 11/18/2022] Open
Abstract
The long-term use of indwelling catheters results in a high risk from urinary tract infections (UTI) and blockage. Blockages often occur from crystalline deposits, formed as the pH rises due to the action of urease-producing bacteria; the most commonly found species being Proteus mirabilis. These crystalline biofilms have been found to develop on all catheter materials with P. mirabilis attaching to all surfaces and forming encrustations. Previous studies have mainly relied on electron microscopy to describe this process but there remains a lack of understanding into the stages of biofilm formation. Using an advanced light microscopy technique, episcopic differential interference contrast (EDIC) microscopy combined with epifluorescence (EF), we describe a non-destructive, non-contact, real-time imaging method used to track all stages of biofilm development from initial single cell attachment to complex crystalline biofilm formation. Using a simple six-well plate system, attachment of P. mirabilis (in artificial urine) to sections of silicone and hydrogel latex catheters was tracked over time (up to 24 days). Using EDIC and EF we show how initial attachment occurred in less than 1 h following exposure to P. mirabilis. This was rapidly followed by an accumulation of an additional material (indicated to be carbohydrate based using lectin staining) and the presence of highly elongated, motile cells. After 24 h exposure, a layer developed above this conditioning film and within 4 days the entire surface (of both catheter materials) was covered with diffuse crystalline deposits with defined crystals embedded. Using three-dimensional image reconstruction software, cells of P. mirabilis were seen covering the crystal surfaces. EDIC microscopy could resolve these four components of the complex crystalline biofilm and the close relationship between P. mirabilis and the crystals. This real-time imaging technique permits study of this complex biofilm development with no risk of artefacts due to sample manipulation. A full understanding of the stages and components involved in crystalline encrustation formation will aid in the development of new protocols to manage and ultimately prevent catheter blockage.
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Affiliation(s)
- Sandra A. Wilks
- Centre for Biological Sciences, Faculty of Natural and Environmental Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
- Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
- * E-mail:
| | - Mandy J. Fader
- Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
| | - C. William Keevil
- Centre for Biological Sciences, Faculty of Natural and Environmental Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
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72
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Marcone Marchitti C, Boarin M, Villa G. Encrustations of the urinary catheter and prevention strategies: an observational study. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2015. [DOI: 10.1111/ijun.12088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Mattia Boarin
- Department of Urology; San Raffaele Hospital; Milan Italy
| | - Giulia Villa
- School of Nursing; Vita-Salute San Raffaele University; Milan Italy
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73
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Wang R, Chua KL, Neoh KG. Bifunctional Coating with Sustained Release of 4-Amide-piperidine-C12 for Long-Term Prevention of Bacterial Colonization on Silicone. ACS Biomater Sci Eng 2015; 1:405-415. [DOI: 10.1021/acsbiomaterials.5b00031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Rong Wang
- Department
of Chemical and Biomolecular Engineering, 4 Engineering Drive 4, National University of Singapore, Kent Ridge, Singapore 117576
| | - Kim Lee Chua
- Department
of Biochemistry, 5 Science
Drive 2, National University of Singapore, Kent Ridge, Singapore 117545
| | - Koon Gee Neoh
- Department
of Chemical and Biomolecular Engineering, 4 Engineering Drive 4, National University of Singapore, Kent Ridge, Singapore 117576
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74
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Marcone Marchitti C, Boarin M, Villa G. Encrustations of the urinary catheter and prevention strategies: a literature review. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2015. [DOI: 10.1111/ijun.12080] [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)
| | - Mattia Boarin
- Department of Urology; San Raffaele Hospital; Milan Italy
| | - Giulia Villa
- School of Nursing; Vita-Salute San Raffaele University; Milan Italy
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75
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Wang TKM, Ahn Y, Dunlop J. Providencia rettgeri peritonitis in a patient on peritoneal dialysis with perforated appendicitis. Perit Dial Int 2015; 34:569-70. [PMID: 25075004 DOI: 10.1177/089686081403400501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tom Kai Ming Wang
- Department of Renal Medicine, Counties Manukau District Health Board, Auckland, New Zealand Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Yeri Ahn
- Department of Renal Medicine, Counties Manukau District Health Board, Auckland, New Zealand Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna Dunlop
- Department of Renal Medicine, Counties Manukau District Health Board, Auckland, New Zealand Faculty of Medical and Health Sciences, University of Auckland, Auckland, New ZealandDepartment of Renal Medicine, Counties Manukau District Health Board, Auckland, New Zealand Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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76
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Colletta A, Wu J, Wo Y, Kappler M, Chen H, Xi C, Meyerhoff ME. S-Nitroso- N-acetylpenicillamine (SNAP) Impregnated Silicone Foley Catheters: A Potential Biomaterial/Device To Prevent Catheter-Associated Urinary Tract Infections. ACS Biomater Sci Eng 2015; 1:416-424. [PMID: 26462294 PMCID: PMC4593359 DOI: 10.1021/acsbiomaterials.5b00032] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/27/2015] [Indexed: 01/26/2023]
Abstract
![]()
Urinary Foley catheters are utilized
for management of hospitalized
patients and are associated with high rates of urinary tract infections
(UTIs). Nitric oxide (NO) potently inhibits microbial biofilm formation,
which is the primary cause of catheter associated UTIs (CAUTIs). Herein,
commercial silicone Foley catheters are impregnated via a solvent
swelling method with S-nitroso-N-acetyl-D-penicillamine (SNAP), a synthetic NO donor that exhibits
long-term NO release and stability when incorporated into low water-uptake
polymers. The proposed catheters generate NO surface-fluxes >0.7
×
10–10 mol min–1 cm–2 for over one month under physiological conditions, with minimal
SNAP leaching. These biomedical devices are demonstrated to significantly
decrease formation of biofilm on the surface of the catheter tubings
over 3, 7, and 14 day periods by microbial species (Staphylococcus
epidermidis and Proteus mirabilis) commonly
causing CAUTIs. Toxicity assessment demonstrates that the SNAP-impregnated
catheters are fully biocompatible, as extracts of the catheter tubings
score 0 on a 3-point grading scale using an accepted mouse fibroblast
cell-line toxicity model. Consequently, SNAP-impregnated silicone
Foley catheters can likely provide an efficient strategy to greatly
reduce the occurrence of nosocomial CAUTIs.
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Affiliation(s)
- Alessandro Colletta
- Department of Chemistry and Department of Environmental Health Sciences, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Jianfeng Wu
- Department of Chemistry and Department of Environmental Health Sciences, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Yaqi Wo
- Department of Chemistry and Department of Environmental Health Sciences, University of Michigan , Ann Arbor, Michigan 48109, United States
| | | | - Hao Chen
- Biocrede Inc. , Plymouth, Michigan 48170, United States
| | - Chuanwu Xi
- Department of Chemistry and Department of Environmental Health Sciences, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Mark E Meyerhoff
- Department of Chemistry and Department of Environmental Health Sciences, University of Michigan , Ann Arbor, Michigan 48109, United States
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77
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Jordan RPC, Malic S, Waters MG, Stickler DJ, Williams DW. Development of an antimicrobial urinary catheter to inhibit urinary catheter encrustation. ACTA ACUST UNITED AC 2015. [DOI: 10.7243/2052-6180-3-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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78
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Donelli G, Vuotto C. Biofilm-based infections in long-term care facilities. Future Microbiol 2014; 9:175-88. [PMID: 24571072 DOI: 10.2217/fmb.13.149] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The recent trend in the early admittance to long-term care facilities (LTCFs) of severely injured patients transferred from general hospitals has given a new dynamic to the incidence of healthcare-associated infections, including biofilm-based infections related to the implant of urinary and intravascular catheters, and the onset of pressure ulcers. Catheter-associated urinary tract infections lead in most of the surveys on LTCFs, approximately 80% of urinary tract infections in these settings being due to the short- or long-term insertion of a urinary catheter. Furthermore, the implantation of intravascular catheters is often responsible for catheter-related bloodstream infections caused by the development of an intraluminal biofilm. Pressure ulcers, frequently occurring in bedridden patients admitted to LTCFs, are also susceptible to infection by biofilm-growing aerobic and anaerobic bacteria, the biofilm formation on the wound being the main reason for its delayed healing.
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79
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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: 108] [Impact Index Per Article: 10.8] [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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80
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Wang R, Neoh KG, Kang ET, Tambyah PA, Chiong E. Antifouling coating with controllable and sustained silver release for long-term inhibition of infection and encrustation in urinary catheters. J Biomed Mater Res B Appl Biomater 2014; 103:519-28. [PMID: 24922113 DOI: 10.1002/jbm.b.33230] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/21/2014] [Accepted: 05/28/2014] [Indexed: 11/09/2022]
Abstract
Urinary tract infections constitute a large proportion of nosocomial infections, and the urinary catheter is the most important predisposing factor. Encrustation induced by urease-producing uropathogens like Proteus mirabilis causes further complications. In the present work, a strategy for controllable and sustained release of silver over several weeks has been developed for combating bacterial infection and encrustation in urinary devices. Silver nanoparticles (AgNPs) were first immobilized on polydopamine (PDA) pre-treated silicone catheter surface and this was followed by another PDA coating. The number of AgNP-PDA bilayers could be manipulated to control the amount of silver loaded and its subsequent release. Poly(sulfobetaine methacrylate-co-acrylamide) was then grafted to provide an antifouling outer layer, and to ensure free diffusion of Ag from the surface. The micron-scale combination of an antifouling coating with AgNP-PDA bilayers reduced colonization of the urinary catheter by uropathogens by approximately two orders of magnitude. With one and two AgNP-PDA bilayers, the coated catheter could resist encrustation for 12 and 45 days, respectively, compared with approximately 6 days with the Dover™ silver-coated catheter. Such anti-infective and anti-encrustation catheters can potentially have a large impact on reducing patient morbidity and healthcare expenditure.
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Affiliation(s)
- Rong Wang
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Kent Ridge, Singapore
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81
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Abstract
Infection urinary stones resulting from urease-producing bacteria are composed by struvite and/or carbonate apatite. Bacterial urease splits urea and promotes the formation of ammonia and carbon dioxide leading to urine alkalinization and formation of phosphate salts. Proteus species are urease-producers, whereas a limited number of strains of other Gram negative and positive species may produce urease. Ureaplasma urealyticum and Corynebacterium urealyticum are urease-producers that are not isolated by conventional urine cultures, but require specific tests for identification. Primary treatment requires surgical removal of stones as complete as possible. Extracorporeal and endoscopic treatments are usually preferred, while open surgery is actually limited to few selected cases. Residual stones or fragments should be treated by chemolysis via ureteral catheter or nephrostomy or administration of citrate salts in order to achieve a stone-free renal unit. Postoperatively, recurrent urinary tract infection should be treated with appropriate antibiotic treatment although long-term antibiotic prophylaxis can cause resistance. Urinary acidification has been proposed for the prophylaxis of infection stones, but long-term acidification is difficult to achieve in urine infected by urease-producing bacteria. Urease inhibitors lead to prevention and/or dissolution of stones and encrustations in patients with infection by urea-splitting bacteria, but their use is limited by their toxicity. The administration of citrate salts involves an increase of the value of nucleation pH (pHn), that is the pH value at which calcium and magnesium phosphate crystallization occurs, in a greater way than the corresponding increase in the urinary pH due to its alkalinizing effect and resulting in a reduction of the risk of struvite crystallization. In conclusion prevention of the recurrence of infection stones can be achieved by an integrated approach tailored on the single patient. Complete clearance of the stone must be achieved by primary surgical procedure and residual fragments should be extensively treated. In the case of persistent infection, conservative measures, such as acidification and urease inhibitors or citrate administration, should be adopted to minimize its effect on urinary saturation with respect to struvite.
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82
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Janssen C, Lo J, Jäger W, Moskalev I, Law A, Chew BH, Lange D. A high throughput, minimally invasive, ultrasound guided model for the study of catheter associated urinary tract infections and device encrustation in mice. J Urol 2014; 192:1856-63. [PMID: 24866596 DOI: 10.1016/j.juro.2014.05.092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Catheter associated urinary tract infections are one of the most common health care associated infections. The condition is frequently complicated by encrustation, which blocks the catheter lumen. Preclinical research is limited by the lack of relevant high throughput and cost-effective animal models. Current models are restricted to female mice, associated with major transurethral loss of catheter materials during micturition, highly invasive and complex. We present an ultrasound guided, minimally invasive model that enables catheter associated urinary tract infection and catheter encrustation studies in each mouse gender. MATERIALS AND METHODS Catheter segments (4 mm) were implanted in murine bladders percutaneously in 15 males and 5 females, and transurethrally in 15 females using the Seldinger technique under ultrasound guidance. Proteus mirabilis was instilled intraluminally. Catheter encrustation was monitored by ultrasound. Bacteria were quantified in urine, and catheters and encrustation were analyzed on day 6 or 21. RESULTS Percutaneous and transurethral catheter implantations were performed in a mean ± SE 3.6 ± 0.8 vs 2.5 ± 0.5 minutes in all mice. Ultrasound confirmed that 100% and 66% of implanted catheters, respectively, remained indwelling during the study period. Catheter encrustation developed in P. mirabilis infected urine 48 hours after instillation and an increase with time was detected by ultrasound. Fourier transform spectroscopy of the encrustation confirmed a typical struvite spectrum. Control catheters remained sterile during 21 days. CONCLUSIONS Our minimally invasive, reproducible percutaneous technique is suitable for studying catheter associated urinary tract infection in each gender. Infecting urine with P. mirabilis generates a preclinical model of catheter encrustation within 3 days. The progression of encrustation can be monitored in vivo by ultrasound, making this image based model suitable for assessing novel antibacterial and anti-encrustation therapies.
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Affiliation(s)
- Claudia Janssen
- Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Department of Urology, Johannes Gutenberg University, Mainz, Germany
| | - Joey Lo
- Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wolfgang Jäger
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Department of Urology, Johannes Gutenberg University, Mainz, Germany
| | - Igor Moskalev
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adrienne Law
- Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ben H Chew
- Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dirk Lange
- Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
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83
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Abstract
Antimicrobial effects of essential oils against bacteria associated with urinary catheter infection was assessed. Tests were performed on 14 different bacterial species cultured either planktonically or as biofilms. Biofilms were found to be up to 8-fold more tolerant of the test agents. Higher antimicrobial tolerance was also evident in tests conducted in artificial urine. Eugenol exhibited higher antimicrobial effects against both planktonic cells and biofilms than did terpinen, tea tree oil, and cineole.
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84
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Renal abscess caused by a Providencia stuartii isolate biochemically misidentified as Pasteurella. J Clin Microbiol 2013; 51:2775-7. [PMID: 23698522 DOI: 10.1128/jcm.00937-13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Providencia stuartii is associated with urinary tract infection (UTI) in catheterized patients. Here we report an abscess containing P. stuartii in a patient with a history of UTI, renal stones, and stent placement. This organism was identified by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry and 16S rRNA gene sequencing following biochemical identification as Pasteurella.
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85
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Lebeaux D, Chauhan A, Rendueles O, Beloin C. From in vitro to in vivo Models of Bacterial Biofilm-Related Infections. Pathogens 2013; 2:288-356. [PMID: 25437038 PMCID: PMC4235718 DOI: 10.3390/pathogens2020288] [Citation(s) in RCA: 300] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 05/01/2013] [Accepted: 05/08/2013] [Indexed: 12/13/2022] Open
Abstract
The influence of microorganisms growing as sessile communities in a large number of human infections has been extensively studied and recognized for 30–40 years, therefore warranting intense scientific and medical research. Nonetheless, mimicking the biofilm-life style of bacteria and biofilm-related infections has been an arduous task. Models used to study biofilms range from simple in vitro to complex in vivo models of tissues or device-related infections. These different models have progressively contributed to the current knowledge of biofilm physiology within the host context. While far from a complete understanding of the multiple elements controlling the dynamic interactions between the host and biofilms, we are nowadays witnessing the emergence of promising preventive or curative strategies to fight biofilm-related infections. This review undertakes a comprehensive analysis of the literature from a historic perspective commenting on the contribution of the different models and discussing future venues and new approaches that can be merged with more traditional techniques in order to model biofilm-infections and efficiently fight them.
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Affiliation(s)
- David Lebeaux
- Institut Pasteur, Unité de Génétique des Biofilms, 25 rue du Dr. Roux, 75724 Paris cedex 15, France.
| | - Ashwini Chauhan
- Institut Pasteur, Unité de Génétique des Biofilms, 25 rue du Dr. Roux, 75724 Paris cedex 15, France.
| | - Olaya Rendueles
- Institut Pasteur, Unité de Génétique des Biofilms, 25 rue du Dr. Roux, 75724 Paris cedex 15, France.
| | - Christophe Beloin
- Institut Pasteur, Unité de Génétique des Biofilms, 25 rue du Dr. Roux, 75724 Paris cedex 15, France.
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86
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Savory N, Lednor D, Tsukakoshi K, Abe K, Yoshida W, Ferri S, Jones BV, Ikebukuro K. In silico maturation of binding-specificity of DNA aptamers against Proteus mirabilis. Biotechnol Bioeng 2013; 110:2573-80. [PMID: 23568752 DOI: 10.1002/bit.24922] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 02/27/2013] [Accepted: 03/29/2013] [Indexed: 01/23/2023]
Abstract
Proteus mirabilis is a prominent cause of catheter-associated urinary tract infections (CAUTIs) among patients undergoing long-term bladder catheterization. There are currently no effective means of preventing P. mirabilis infections, and strategies for prophylaxis and rapid early diagnosis are urgently required. Aptamers offer significant potential for development of countermeasures against P. mirabilis CAUTI and are an ideal class of molecules for the development of diagnostics and therapeutics. Here we demonstrate the application of Cell-SELEX to identify DNA aptamers that show high affinity for P. mirabilis. While the aptamers identified displayed high affinity for P. mirabilis cells in dot blotting assays, they also bound to other uropathogenic bacteria. To improve aptamer specificity for P. mirabilis, an in silico maturation (ISM) approach was employed. Two cycles of ISM allowed the identification of an aptamer showing 36% higher specificity, evaluated as a ratio of binding signal for P. mirabilis to that for Escherichia coli (also a cause of CAUTI and the most common urinary tract pathogen). Aptamers that specifically recognize P. mirabilis would have diagnostic and therapeutic values and constitute useful tools for studying membrane-associated proteins in this organism.
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Affiliation(s)
- Nasa Savory
- Department of Biotechnology and Life Science, Tokyo University of Agriculture and Technology, 2-24-16 Naka-cho, Koganei, Tokyo, 184-8588, Japan
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87
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Biegen VR, Slusser PG, Fischetti AJ, Geist MR. Successful treatment of encrusted cystitis associated withStaphylococcus pseudintermediusinfection in the urinary bladder of a dog. J Am Vet Med Assoc 2013; 242:798-802. [DOI: 10.2460/javma.242.6.798] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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88
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Encrustation of urologic double pigtail catheters-an ex vivo optical coherence tomography (OCT) study. Lasers Med Sci 2012; 28:919-24. [PMID: 22869160 DOI: 10.1007/s10103-012-1177-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 07/20/2012] [Indexed: 10/28/2022]
Abstract
This study aims to evaluate whether optical coherence tomography (OCT) using both the surface and the endoluminal technique is feasible to investigate the locations and degree of encrustation process in clinically used ureteral stents. After removal from patients, 14 polyurethane JJ stents were investigated. A fresh JJ served as a control. The external surfaces were examined using an endoscopic surface OCT whereas the intraluminal surfaces were investigated by an endoluminal radial OCT device. The focus was on detection of encrustation or crystalline sedimentation. In 12 female and two male patients, the median indwelling time of the ureteral catheter was 100 days (range, 19-217). Using the endoluminal OCT, the size and grade of intraluminal encrustation could be expressed as a percentage relating to the open lumen of the reference stent. The maximum encrustation observed resulted in a remaining unrestricted lumen of 15-35 % compared to the reference. The luminal reduction caused by encrustation was significantly higher at the proximal end of the ureteral stent as compared to its distal part. The extraluminal OCT investigations facilitated the characterization of extraluminal encrustation. OCT techniques were feasible and facilitated the detection of encrustation of double pigtail catheters on both the extra and intra luminal surface. Quantitative expression of the degree of intraluminal encrustation could be achieved, with the most dense and thickened occurrence of intraluminal incrustation in the upper curl of the JJ stent.
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89
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Chen CY, Chen YH, Lu PL, Lin WR, Chen TC, Lin CY. Proteus mirabilis urinary tract infection and bacteremia: Risk factors, clinical presentation, and outcomes. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 45:228-36. [DOI: 10.1016/j.jmii.2011.11.007] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 07/23/2011] [Accepted: 08/02/2011] [Indexed: 11/24/2022]
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90
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Abstract
Congenital anomalies such as meningomyelocele and diseases/damage of the central, peripheral, or autonomic nervous systems may produce neurogenic bladder dysfunction, which untreated can result in progressive renal damage, adverse physical effects including decubiti and urinary tract infections, and psychological and social sequelae related to urinary incontinence. A comprehensive bladder-retraining program that incorporates appropriate education, training, medication, and surgical interventions can mitigate the adverse consequences of neurogenic bladder dysfunction and improve both quantity and quality of life. The goals of bladder retraining for neurogenic bladder dysfunction are prevention of urinary incontinence, urinary tract infections, detrusor overdistension, and progressive upper urinary tract damage due to chronic, excessive detrusor pressures. Understanding the physiology and pathophysiology of micturition is essential to select appropriate pharmacologic and surgical interventions to achieve these goals. Future perspectives on potential pharmacological, surgical, and regenerative medicine options for treating neurogenic bladder dysfunction are also presented.
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Affiliation(s)
- Peter T. Dorsher
- Department of Physical Medicine and Rehabilitation, Mayo College of Medicine, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Peter M. McIntosh
- Department of Physical Medicine and Rehabilitation, Mayo College of Medicine, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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91
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Influence of quorum sensing signal molecules on biofilm formation in Proteus mirabilis O18. Folia Microbiol (Praha) 2011; 57:53-60. [PMID: 22198843 PMCID: PMC3297748 DOI: 10.1007/s12223-011-0091-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 12/06/2011] [Indexed: 11/15/2022]
Abstract
The influence of basis of quorum sensing molecules on Proteus strains is much less known as compared to Pseudomonas or Escherichia. We have previously shown that a series of acylated homoserine lactones (acyl-HSL) does not influence the ureolytic, proteolytic, or hemolytic abilities, and that the swarming motility of Proteus mirabilis rods is strain specific. The aim of the presented study was to find out if the presence of a series of acyl-HSL influences biofilm formation of P. mirabilis laboratory strain belonging to O18 serogroup. This serogroup is characterized by the presence of a unique non-carbohydrate component, namely phosphocholine. Escherichia coli and P. mirabilis O18 strains used in this work contains cloned plasmids encoding fluorescent protein genes with constitutive gene expression. In mixed biofilms in stationary and continuous flow conditions, P. mirabilis O18 overgrow whole culture. P. mirabilis O18 strain has genetically proved a presence of AI–2 quorum sensing system. Differences in biofilm structure were observed depending on the biofilm type and culture methods. From tested acylated homoserine lactones (BHL, HHL, OHL, DHL, dDHL, tDHL), a significant influence had BHL on thickness, structure, and the amount of exopolysaccharides produced by biofilms formed by P. mirabilis O18 pDsRed2.
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92
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Malic S, Waters MGJ, Basil L, Stickler DJ, Williams DW. Development of an “early warning” sensor for encrustation of urinary catheters following Proteus infection. J Biomed Mater Res B Appl Biomater 2011; 100:133-7. [DOI: 10.1002/jbm.b.31930] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 07/06/2011] [Accepted: 07/07/2011] [Indexed: 11/06/2022]
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93
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Lee G, Hong JH. Xanthogranulomatous pyelonephritis with nephrocutaneous fistula due to Providencia rettgeri infection. J Med Microbiol 2011; 60:1050-1052. [PMID: 21459904 DOI: 10.1099/jmm.0.028977-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We describe what is to our knowledge the first case of xanthogranulomatous pyelonephritis combined with nephrocutaneous fistula caused by Providencia rettgeri. Surgical extirpation including nephrectomy and fistulectomy was successfully performed. The strain was identified by 16S rRNA gene sequencing in both renal tissue and pus culture from the fistula.
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Affiliation(s)
- Gilho Lee
- Department of Urology, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Jeong Hee Hong
- Department of Urology, Dankook University College of Medicine, Cheonan, Republic of Korea
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94
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Desai DG, Liao KS, Cevallos ME, Trautner BW. Silver or nitrofurazone impregnation of urinary catheters has a minimal effect on uropathogen adherence. J Urol 2010; 184:2565-71. [PMID: 21030042 DOI: 10.1016/j.juro.2010.07.036] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE Bacterial adherence to the urinary catheter is an early step in biofilm formation and the pathogenesis of catheter associated urinary tract infection. We studied in vitro the effect of silver or nitrofurazone impregnation of urinary catheters on uropathogen ability to adhere to urinary catheters. MATERIALS AND METHODS We studied commercially available nitrofurazone-silicone, silicone only, silver-silicone-hydrogel, silicone-hydrogel, silver-latex-hydrogel and latex-hydrogel catheters. Catheters were incubated in sterile broth for 0, 3, 5, 7 and 10 days, respectively, before inoculation and overnight incubation with Escherichia coli or Enterococcus faecalis. RESULTS Adherence of E. coli and E. faecalis to nitrofurazone catheters was significantly decreased compared to that of silicone-only catheters when catheters were fresh. The anti-adherence effect of nitrofurazone on E. coli decreased with time but was still significant at 5 days. For E. faecalis the effect of nitrofurazone was lost by 3 days of pre-incubation. E. coli adherence was not significantly decreased on silver impregnated catheters compared to that on control catheters of the same base material. Silver was associated with a significant decrease in E. faecalis adherence to latex-hydrogel catheters but not to silicone-hydrogel catheters. The adherence of each species to silicone catheters with hydrogel was significantly lower than that to silicone-only control catheters. CONCLUSIONS Silver impregnation had little effect on bacterial adherence in our model and nitrofurazone impregnation had a significant effect only for the first 5 days. Our results do not support a role for silver urinary catheters to prevent catheter associated urinary tract infection by decreasing bacterial adherence.
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Affiliation(s)
- Devak G Desai
- Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center, Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA
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Cazander G, van de Veerdonk MC, Vandenbroucke-Grauls CMJE, Schreurs MWJ, Jukema GN. Maggot excretions inhibit biofilm formation on biomaterials. Clin Orthop Relat Res 2010; 468:2789-96. [PMID: 20309656 PMCID: PMC2939353 DOI: 10.1007/s11999-010-1309-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 03/02/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biofilm-associated infections in trauma surgery are difficult to treat with conventional therapies. Therefore, it is important to develop new treatment modalities. Maggots in captured bags, which are permeable for larval excretions/secretions, aid in healing severe, infected wounds, suspect for biofilm formation. Therefore we presumed maggot excretions/secretions would reduce biofilm formation. QUESTIONS/PURPOSES We studied biofilm formation of Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella oxytoca, Enterococcus faecalis, and Enterobacter cloacae on polyethylene, titanium, and stainless steel. We compared the quantities of biofilm formation between the bacterial species on the various biomaterials and the quantity of biofilm formation after various incubation times. Maggot excretions/secretions were added to existing biofilms to examine their effect. METHODS Comb-like models of the biomaterials, made to fit in a 96-well microtiter plate, were incubated with bacterial suspension. The formed biofilms were stained in crystal violet, which was eluted in ethanol. The optical density (at 595 nm) of the eluate was determined to quantify biofilm formation. Maggot excretions/secretions were pipetted in different concentrations to (nonstained) 7-day-old biofilms, incubated 24 hours, and finally measured. RESULTS The strongest biofilms were formed by S. aureus and S. epidermidis on polyethylene and the weakest on titanium. The highest quantity of biofilm formation was reached within 7 days for both bacteria. The presence of excretions/secretions reduced biofilm formation on all biomaterials. A maximum of 92% of biofilm reduction was measured. CONCLUSIONS Our observations suggest maggot excretions/secretions decrease biofilm formation and could provide a new treatment for biofilm formation on infected biomaterials.
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Affiliation(s)
- Gwendolyn Cazander
- Department of Trauma Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | | | | | - Marco W. J. Schreurs
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Gerrolt N. Jukema
- Department of Trauma Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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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: 92] [Impact Index Per Article: 6.6] [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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