Types of urethral catheters for management of short-term voiding problems in hospitalized adults: A short version cochrane review

Deposition of Daldinia starbaeckii (ELF) functionalized silver nanoparticles on urinary catheter tube using chitosan polymer to prevent microbial biofilms formation during UTI infection

Catheter-associated urinary tract infections (CAUTI) are the most common healthcare problem in hospitals. In this study, we isolated the Daldinia starbaeckii (An endolichenic fungus from Roccella montagnie) and its biomass extract were used to simultaneously synthesize and deposit DSFAgNPs on the inner and outer surfaces of the catheter tube using chitosan biopolymer via In-situ deposition method. Perfectly designed D. starbaeckii extract functionalized DSFAgNPs were characterized by UV spectroscopy, FTIR, SEM, EDS, TEM, and XRD. The microbial efficacy of DSFAgNPs & DSFAgNPs coated catheter (CTH3) was evaluated against eight human pathogenic gram (+ / -) ive strains and Candida albicans. Results indicated DSFAgNPs showed significant biological activity against both gram (+ / -) ive bacteria with an average MIC90 of 4 µl/ml. The most promising activity was observed against Helicobacter pylori. When bacteria strains allow to grow with CTH3 we reported significant reduction in colony formation unit (CFU/ml) in broth culture assay with an average 70% inhibition. Further, antibiofilm activity of CTH3 against P. aeruginosa showed strong inhibition of biofilm formation (85%). The study explored an alternate approach for significantly prevent CAUTI among hospital patients. We isolated an endolichenic fungus from lichen Roccella montagnei. The molecular characterization of fungus identified as Daldinia starbaeckii (DSF). The DSF was cultured and its fungal biomass exudes were used to simultaneously construct DSF-AgNPs and its deposition on the catheter surface using biopolymer chitosan via In-situ deposition method. Further, antimicrobial and antibiofilm efficacy of DSF-AgNPs was checked against urinary catheter contaminating and human pathogenic bacterial strains. Based on our research, we determined that DSF-AgNPs coating on a urinary catheter through this method is a cost-effective, eco-friendly approach to prevent catheter contamination.

A randomized, single-blind, multi-center clinical observational study of a new super lubricath coating catheter latex catheters using in urethral catheterization

Polymer polyvinylpyrrolidone (PVP) can be described as the main coating. After heating and curing, it is able to build a strong adhesion to the latex catheter for creating a durable and effective hydrophilic coating. In this study, we aim to explore the advantages and disadvantages of the new super lubricath latex catheter PVP coating compared with the common latex catheter. 148 patients who participated in the study were completely randomly divided into two groups, the observation group and the control group. When the urinary catheter was incubated, indwelling in subjects' body, and removed from the subjects, the researchers accordingly recorded the subjects' comfort feedback, device safety evaluation and the patient's vital signs, relevant blood and urine examination index, electrocardiogram (ECG) changes and recorded various adverse events. PVP super lubricath coating latex catheter offered better comfort, less damage to the urethra, and no significant disadvantage in safety compared to regular latex catheters, improving quality of care and patient satisfaction compared to regular latex urinary catheters.

Convergence of Biofilm Formation and Antibiotic Resistance in Acinetobacter baumannii Infection

Acinetobacter baumannii (A. baumannii) is a leading cause of nosocomial infections as this pathogen has certain attributes that facilitate the subversion of natural defenses of the human body. A. baumannii acquires antibiotic resistance determinants easily and can thrive on both biotic and abiotic surfaces. Different resistance mechanisms or determinants, both transmissible and non-transmissible, have aided in this victory over antibiotics. In addition, the propensity to form biofilms (communities of organism attached to a surface) allows the organism to persist in hospitals on various medical surfaces (cardiac valves, artificial joints, catheters, endotracheal tubes, and ventilators) and also evade antibiotics simply by shielding the bacteria and increasing its ability to acquire foreign genetic material through lateral gene transfer. The biofilm formation rate in A. baumannii is higher than in other species. Recent research has shown how A. baumannii biofilm-forming capacity exerts its effect on resistance phenotypes, development of resistome, and dissemination of resistance genes within biofilms by conjugation or transformation, thereby making biofilm a hotspot for genetic exchange. Various genes control the formation of A. baumannii biofilms and a beneficial relationship between biofilm formation and "antimicrobial resistance" (AMR) exists in the organism. This review discusses these various attributes of the organism that act independently or synergistically to cause hospital infections. Evolution of AMR in A. baumannii, resistance mechanisms including both transmissible (hydrolyzing enzymes) and non-transmissible (efflux pumps and chromosomal mutations) are presented. Intrinsic factors [biofilm-associated protein, outer membrane protein A, chaperon-usher pilus, iron uptake mechanism, poly-β-(1, 6)-N-acetyl glucosamine, BfmS/BfmR two-component system, PER-1, quorum sensing] involved in biofilm production, extrinsic factors (surface property, growth temperature, growth medium) associated with the process, the impact of biofilms on high antimicrobial tolerance and regulation of the process, gene transfer within the biofilm, are elaborated. The infections associated with colonization of A. baumannii on medical devices are discussed. Each important device-related infection is dealt with and both adult and pediatric studies are separately mentioned. Furthermore, the strategies of preventing A. baumannii biofilms with antibiotic combinations, quorum sensing quenchers, natural products, efflux pump inhibitors, antimicrobial peptides, nanoparticles, and phage therapy are enumerated.

Synthesis, Molecular and Supramolecular Structure Aspects, and Antimicrobial Activity of the Centrosymmetric [Ag(5-Nitroquinoline)2]ClO4 Complex

The new homoleptic [Ag(5-nitroquinoline)2]ClO4 centrosymmetric complex was synthesized and its structure aspects were investigated. It crystallized in the monoclinic space group C2/c with a = 10.0279(2) Å, b = 13.2295(3) Å, c = 14.7552(3) Å and β = 102.1050(10)° while V = 1913.96(7) Å3 and half molecule as asymmetric formula. The Ag(I) is coordinated with two symmetrically related 5-nitroquinoline ligand units via the heterocyclic nitrogen atom with Ag-N distance of 2.146(6) Å and N1-Ag-N1 angle of 173.0(3)°. The two coordinated 5-nitroquinoline have anti configuration to one another and the perchlorate anion is set freely uncoordinated. The only Ag…O interactions are Ag1…O2 (3.110 Å) and Ag1…O1 (3.189 Å) which occur between the Ag(I) in one complex unit and the O-atoms from the NO2 groups in the neighbouring complex units. Hence, Ag(I) has coordination number 2 and its coordination geometry is slightly bent. Hirshfeld analysis indicated that the O…H (51.1%), C…H (11.8%), H…H (10.8%) and C…C (8.9%) contacts are the most common. Exclusively, the O…H, C…O, N…O, O…O and Ag…O contacts are the only shorter contacts than the vdWs radii sum of the interacting atoms. The studied Ag(I) complex showed good antimicrobial activity. It has comparable antibacterial activity against P. vulgaris (MIC = 9.7 μg/mL) and S. aureus (39.1 μg/mL) to Gentamycin (4.8 and 9.7 μg/mL, respectively) while better antifungal activity against A. fumigatus (MIC = 39.1 μg/mL) than Ketoconazole (156.2 μg/mL).

Effectiveness of Acupuncture on Urinary Retention: A Meta-Analysis

Objectives

This study aimed to evaluate the safety and efficacy of acupuncture in the treatment of urinary retention (UR).

Methods

Randomized controlled trials investigating the effectiveness of acupuncture in the treatment of UR were identified by searching seven comprehensive databases (Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, and Chinese Biomedical Literature Database) prior to September 2020. Data analysis was performed using RevMan, version 5.3, and Stata software, version 14.0.

Results

A total of 12 studies with 979 participants were included. A random-effects model was used to conduct a meta-analysis on the acupuncture group and the control group. The results show that acupuncture can effectively promote spontaneous urination and reduce anxiety in patients with poor urination (relative risk: 1.35; 95% confidence interval (CI): 1.19–1.53; P < 0.00001). The random-effects model showed significant differences in residual urine volume between the acupuncture group and the control group (MD: −84.79, 95% CI: −135.62 to −33.94; P=0.001).

Conclusion

Acupuncture is safe and effective in the treatment of UR. However, since the current level of evidence is limited, high-quality, large-sample, multi-center, clinical randomized controlled trials are needed to further confirm our conclusions in the future.

The prospects of antimicrobial coated medical implants

The implants are increasingly being a part of modern medicine in various surgical procedures for functional or cosmetic purposes. The progressive use of implants is associated with increased infectious complications and prevention of such infections always remains precedence in the clinical settings. The preventive approaches include the systemic administration of antimicrobial agents before and after the surgical procedures as well as the local application of antibiotics. The relevant literature and existing clinical practices have highlighted the role of antimicrobial coating approaches in the prevention of implants associated infections, although the applications of these strategies are not yet standardized, and the clinical efficacy is not much clear. The adequate data from the randomized control trials is challenging because of the unavailability of a large sample size although it is compulsory in this context to assess the clinical efficacy of preemptive practices. This review compares the efficacy of preventive approaches and the prospects of antimicrobial-coated implants in preventing implant-related infections.

Proteus mirabilis Biofilm: Development and Therapeutic Strategies

Proteus mirabilis is a Gram negative bacterium that is a frequent cause of catheter-associated urinary tract infections (CAUTIs). Its ability to cause such infections is mostly related to the formation of biofilms on catheter surfaces. In order to form biofilms, P. mirabilis expresses a number of virulence factors. Such factors may include adhesion proteins, quorum sensing molecules, lipopolysaccharides, efflux pumps, and urease enzyme. A unique feature of P. mirabilis biofilms that build up on catheter surfaces is their crystalline nature owing to their ureolytic biomineralization. This leads to catheter encrustation and blockage and, in most cases, is accompanied by urine retention and ascending UTIs. Bacteria embedded in crystalline biofilms become highly resistant to conventional antimicrobials as well as the immune system. Being refractory to antimicrobial treatment, alternative approaches for eradicating P. mirabilis biofilms have been sought by many studies. The current review focuses on the mechanism by which P. mirabilis biofilms are formed, and a state of the art update on preventing biofilm formation and reduction of mature biofilms. These treatment approaches include natural, and synthetic compounds targeting virulence factors and quorum sensing, beside other strategies that include carrier-mediated diffusion of antimicrobials into biofilm matrix. Bacteriophage therapy has also shown successful results in vitro for combating P. mirabilis biofilms either merely through their lytic effect or by acting as facilitators for antimicrobials diffusion.

Supercritical Fluid Applications in the Design of Novel Antimicrobial Materials

Bacterial resistance to antibiotics is one of the biggest problems in the modern world. The prevention of bacterial spreading from hospitals to the community and vice versa is an issue we have to deal with. This review presents a vast potential of contemporary high-pressure techniques in the design of materials with antimicrobial activity. Scientists from all over the world came up with ideas on how to exploit extraordinary properties of supercritical fluids in the production of advantageous materials in an environmentally friendly way. The review summarizes reported methods and results.

Early versus delayed urinary catheter removal after hysterectomy: A systematic review and meta-analysis

OBJECTIVES

In bladder drainage, an essential part of post-hysterectomy care, the optimal timing for removing the urinary catheter is unclear. Our objective was to evaluate the risks and benefits of early (<6 h) vs delayed (>6 h) catheter removal post-hysterectomy.

STUDY DESIGN

A systematic review searching MEDLINE, EMBASE and Cochrane CENTRAL from inception till May 2019 for randomised trials of women undergoing hysterectomy. We reported on urinary retention, positive urine culture, urinary tract infection (UTI) (defined by symptoms and/or antibiotic use), post-operative pyrexia, time to ambulation, and length of hospital stay. We assessed risk of bias in included trials and used a random-effect model to generate risk ratios (RR) for dichotomous outcomes and weighted mean differences (WMD) for continuous outcomes, with 95 % confidence intervals (CI).

RESULTS

Of 1020 potentially relevant citations, we included 10 randomised trials (1120 women). Four trials had low risk of bias for randomisation and allocation concealment while five had low risk for outcome assessment and selective reporting. Compared to delayed removal, women in the early catheter removal group had a higher risk of urinary retention and needing re-catheterisation (10 RCTs, RR 3.61, 95 %CI 1.21-9.21, I² = 56 %). There was some reduction in the risk of post-operative UTI (6 RCTs, RR 0.42, 95 %CI 0.18 to 0.96, I² = 0 %), but we did not find a significant difference in post-operative pyrexia (6 RCTs, RR 0.73, 95 %CI 0.43-1.24, I² = 18 %) or positive urine cultures (6 RCTs, RR of 0.56, 95 %CI 0.27-1.12, I² = 55 %). There was no significant difference in the average time to ambulation (3RCTs, WMD -4.6, 95 %CI -9.16 to -0.18, I² = 98 %) and length of hospital stay (3RCTs, WMD -1.05, 95 %CI -2.42 to 0.31, I² = 98 %). Our meta-regression on the provision of prophylactic antibiotics did not show a significant effect on the reported outcomes. Our analysis was limited by our inability to adjust for potential effect modifiers such as the surgical route.

CONCLUSIONS

Early removal of the urinary catheter <6 h post-hysterectomy seems to increase the risk of urinary retention and needing re-catheterisation, but may reduce post-operative UTI.

Same sized three-way indwelling urinary catheters from various manufacturers present different irrigation and drainage properties

Background:

The three-way indwelling urinary catheter (IUC) is used for continuous bladder irrigation and is considered the cornerstone for clinical treatment of patients with macroscopic hematuria. Although there seems to be a logical relationship between catheter size and efficacy of irrigation and drainage, we often observe relevant variations in these parameters between different brands of catheters available on the market. The aim of this study was to compare the mechanical properties of different models of latex and silicone three-way catheters in an in vitro setting that resembles clinical use.

Methods:

Three different three-way catheters were evaluated: Gold Silicone-Coated Rusch^® (Model A), 100% Silicone Rusch^® (Model B) and X-Flow Coloplast^® (Model C). Irrigation channel, drainage channel, and overall cross-sectional areas were all digitally measured. Irrigation and drainage channel flow rates were measured and correlated with their corresponding catheter cross-sectional area values.

Results:

Different catheter models of the same caliber have different internal irrigation port diameters, internal drainage port diameters and internal cuff port diameters. The Model C IUC internal irrigation port diameter is significantly larger than models A and B. When flows were evaluated, we found that in the same model, the increase in caliber of the IUC was related to an increased drainage flow, but not to an increased irrigation flow.

Conclusion:

Precise measurements of the internal architecture of the three-way catheter, rather than relying on the caliber itself, could assist surgeons in choosing the best product for each specific patient, while minimizing complications.

Chitosans as new tools against biofilms formation on the surface of silicone urinary catheters

Urinary catheters contamination by microorganisms is a major cause of hospital acquired infections and represents a limitation for long-term use. In this work, biofilms of Klebsiella pneumoniae and Escherichia coli clinical isolates were developed on urinary catheters for 48 and 72 h in artificial urine medium (AUM) with different molecular weight chitosans (AUM-CS solutions) at pH 5.0. The number of viable bacteria was determined by standard plate count agar while crystal violet (CV) staining was carried out to assess biomass production (optical density at 570 nm) in the mentioned conditions. Re-growth of each strain was also evaluated after 24 h re-incubation of the treated catheters. Significant decreases of log CFU/catheter and biomass production were observed for all the biofilms developed in AUM-CS compared with the controls in AUM. The percentages of biofilm removal were slightly higher for E. coli biofilms (up to 90.4%) than those of K. pneumoniae (89.7%); in most cases, the complete inhibition of bacterial re-growth on treated catheter pieces was observed. Contact time influenced chitosan efficacy rather than its molecular weight or the biofilms age. The results confirmed the potentiality of chitosans as a biomacromolecule tool to contrast biofilm formation and reduce bacterial re-growth on urinary catheters.

Evaluation of Antimicrobial Durability and Anti-Biofilm Effects in Urinary Catheters Against Enterococcus faecalis Clinical Isolates and Reference Strains

BACKGROUND

Enterococcus faecalis, Escherichia coli, Staphylococcus epidermidis, Pseudomonas aeruginosa and Candida albicans biofilms are major causes of catheter-associated urinary tract infections. Antimicrobial-coated or impregnated urinary catheters are seen as a possible way to prevent these infections.

AIMS

To determine the biofilm-forming ability of 89 E. faecalis isolates from urinary tract infections and to compare several urinary catheters for antimicrobial durability and the inhibitory effects on biofilm formation of different laboratory strains and clinical isolates of E. faecalis.

STUDY DESIGN

In vitro experimental study.

METHODS

The biofilm forming ability of E. faecalis isolates was determined by the crystal violet staining and plate counting methods. For comparison of urinary catheters, biofilms of 45 E. faecalis isolates from the catheter samples of hospitalized patients and five laboratory strains of E. coli ATCC25922, S. epidermidis ATCC35984, P. aeruginosa ATCC27853, E. faecalis ATCC29212 and C. albicans ATCC90028 were formed on the catheters in 24-well tissue culture plates. Scanning electron microscopy analysis was performed to observe biofilms.

RESULTS

All 89 E. faecalis isolates were found to be biofilm positive. Nitrofurazone-impregnated catheters significantly reduced the cell counts of E. faecalis isolates and completely inhibited the formation of P. aeruginosa and S. epidermidis biofilms compared with the others. Regarding reduction of biofilm cell counts, a hydrophilic-coated catheter was more effective against P. aeruginosa, whereas a silver-coated catheter was found to be more effective against S. epidermidis. The nitrofurazone-impregnated catheter had the best antimicrobial durability.

CONCLUSION

Urine isolates of E. faecalis had considerable ability with respect to biofilm formation. The nitrofurazone-impregnated catheter was the most effective against all tested bacteria; however, the effect of a hydrophilic or silver-coated catheter depends on the species present in it.

Evaluation of central venous catheters coated with a noble metal alloy-A randomized clinical pilot study of coating durability, performance and tolerability

The use of Central Venous Catheters (CVCs) commonly results in complications. Coatings with silver or metal alloys can reduce the risk associated with the use of CVC. We have evaluated the durability of a noble metal coated CVC (the Bactiguard Infectious Protection, BIP CVC) and compared with an uncoated CVC for clinical tolerability (Adverse Events, AEs) and performance, in order to create a baseline for a large future study. Patients undergoing major surgery, randomised at a 2:1 ratio to BIP CVC (n = 22) or standard CVC (n = 12), were catheterized 9 ‐ 12 days, respectively. Adverse events, microbial colonization and metal release were measured.

Findings: There were no AEs in the BIP CVC‐group, but 5 AEs occurred in 4 patients (1 patient had 2 AEs) in the standard CVC‐group, p = 0.011 (whereof 3 were catheter related). The BIP CVC showed an initial release of coating metals in blood (gold, silver and palladium), which rapidly decreased and were far below Permitted Paily Exposure (PDE) for chronical use. The levels of silver concentration were far below those needed to develop microbial resistance. The performance was equal, and there was no difference concerning microbial colonization, for the two CVCs.

Conclusion: In this pilot study the BIP CVC had significantly lower AEs and showed a comparable performance to the standard CVC. The coating was durable throughout the study length (up to 16 days) and toxicological evaluation showed good safety margins. Larger studies are needed. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2337–2344, 2018.

Antifouling and antimicrobial biomaterials: an overview

The use of implantable medical devices is a common and indispensable part of medical care for both diagnostic and therapeutic purposes. However, as side effect, the implant of medical devices quite often leads to the occurrence of difficult-to-treat infections, as a consequence of the colonization of their abiotic surfaces by biofilm-growing microorganisms increasingly resistant to antimicrobial therapies. A promising strategy to combat device-related infections is based on anti-infective biomaterials that either repel microbes, so they cannot attach to the device surfaces, or kill them in the surrounding areas. In general, such biomaterials are characterized by antifouling coatings, exhibiting low adhesion or even repellent properties towards microorganisms, or antimicrobial coatings, able to kill microbes approaching the surface. In this light, the present overview will address the development in the last two decades of antifouling and antimicrobial biomaterials designed to potentially limit the initial stages of microbial adhesion, as well as the microbial growth and biofilm formation on medical device surfaces.

Intermittent self-catheterisation for urolgical problems caused by FGM

This is the fourth and final article in a series on female genital mutilation (FGM). It describes the complications of FGM, with a focus on the urinary ones. FGM refers to all procedures that involve partial or total removal of the external female genitalia and/or damage to other female genital organs for non-medical reasons. The World Health Organization (WHO) has classified FGM into four types (1-4). Women who have type 3 commonly experience long-term complications of their urological tract. The first-line treatment for type 3 FGM involves surgical defibulation, but this is not always successful and women can be left with neurogenic bladder dysfunction and urethral stricture disease. Intermittent self-catheterisation (ISC) enables these women to have control of their bladder function.

Tolerability and performance of BIP endotracheal tubes with noble metal alloy coating--a randomized clinical evaluation study

Background

Hospital acquired infections worsen the outcome of patients treated in intensive care units and are costly. Coatings with silver or metal alloys may reduce or alter the formation of biofilm on invasive medical devices. An endotracheal tube (ETT) is used to connect the patient to a ventilator and coated tubes have been tested in relation to bacterial colonization and respiratory infection. In the present study, we aimed to evaluate and compare a coated and uncoated ETT for patient symptoms and local tracheal tolerability during short term clinical use. Degree of bacterial colonization was also described.

Methods

A silver-palladium-gold alloy coating (‘Bactiguard®’Infection Protection, BIP) has been extensively used on urinary tract catheters and lately also on central venous catheters. We performed a randomised, single-blinded, controlled, first in man, post Conformité Européenne (EC) certification and CE marking study, focused on Bactiguard® coated ETTs (BIP ETT). Thirty patients at a tertiary university hospital scheduled for upper abdominal elective surgery with an expected duration of anaesthesia of at least 3 h were randomised; BIP ETT (n = 20) or standard ETT (n = 10). The tolerability was assessed with a modified version of Quality of Life Head and Neck Module, QLQ-H&N35 and by inspection of the tracheal mucosa with a fibre-optic bronchoscope before intubation and at extubation. Adverse Events (AE) and bacterial adherence were also studied. Statistical evaluations were carried out with the Fisher’s Exact Test, the Clopper-Pearson method, as well as a Proportional Odds Model.

Results

Differences between groups were identified in 2 of 8 patient related symptoms with regard to tolerability by QLQ-H&N35 (cough, p = 0.022 and dry mouth, p = 0.014 in the treatment group.). No mucosal damage was identified with bronchoscopy. A low level of bacterial colonization with normal flora, equal between groups, was seen after short-term of intubation (median 5 h). No serious Adverse Events related to the use of an ETT were observed. The results should be treated with caution due to statistical confounders, a small study size and large inter-individual variability in bacterial adhesion.

Conclusions

The new device BIP ETT is well tolerated and has good clinical performance during short-term intubation. Studies with larger sample sizes and longer intubation periods (>24 h) in the ICU-setting are needed and can now be planned in order to identify possible differences in clinical outcomes.

Trial registration

Registered in ClinicalTrials.gov, Registration number: NCT01682486, Date of Registration: August, 30, 2012

Investigation of Antibacterial Activity and Biofilm Formation of Silicones Coated With Minocycline-Rifampicin, Silver Nitrate, and Nitrofurantoin for Short-term Utilization in In Vitro Urinary System Models

OBJECTIVE

To analyze antimicrobial activity and biofilm formation on silicones coated with antimicrobial substances in in vivo short-term catheterization simulation using our newly developed in vitro urinary system model and to compare minocycline-rifampin (MR)-, silver nitrate-, and nitrofurantoin (NF)-coated silicone discs.

MATERIALS AND METHODS

Silicone discs were exposed to bacterial urine suspension for 168 hours. The antimicrobial activities were assessed in the medium, and the inhibition zone diameters were measured. The weight of the silicones was measured for biofilm growth assessment before and after the experiment, and confocal microscopy images were taken.

RESULTS

Although the inhibition zone diameters of silver nitrate silicones were larger than those of pure silicone (PS), MR, and NF silicones, biofilm formation could not be prevented (P < .05). MR and NF silicones were superior to PS in terms of antimicrobial efficacy and prevention of biofilm formation (P < .05). In terms of biofilm prevention, no differences were detected between NF and MR silicones apart from a slightly superior ability of MR silicones to inhibit Escherichia coli (P > .05). Biofilm formation occurred on all silicone discs.

CONCLUSION

In short-term urinary catheter utilization, antimicrobial efficacy and biofilm formation prevention were superior in coated silicones, regardless of the type of antibiotic used, compared with the control group (PS). As the study was conducted in an in vitro setting, the findings should be substantiated with in vivo studies on the grounds that different results may be obtained in these settings.

A comparison between foley and nelatone urinary catheters in causing urinary tract infection in animal models

BACKGROUND

Urinary catheterization is one of the main measures used to treat and care for hospitalized patients. Several complications have been attributed to the presence of latex with routine Foley catheters. Therefore, some studies have recommended that Nelatone catheters be substituted for the ordinary Foley catheters to prevent these complications.

OBJECTIVES

This study aimed to compare the rates of urinary tract infection (UTI) in rabbits catheterized either with Foley or with Nelatone catheters.

MATERIALS AND METHODS

A randomized controlled trial was conducted on 60 rabbits that were randomly assigned to three groups of twenty. The first group was catheterized using Nelatone catheter; the second group was catheterized using Foley catheter and the third group was studied without performing any catheterization. After seven days, urine samples were collected using suprapubic aspiration and were sent to the laboratory for culture. Descriptive statistics were calculated. Moreover, chi-square and Fisher's exact tests were used for data analysis.

RESULTS

At the end of the study, four cases in the Nelatone group and 12 cases in the Foley group presented with UTI (P = 0.01). No positive urine cultures were found in the control group.

CONCLUSIONS

The Nelatone catheters, compared with the Foley ones, had a lower risk of UTI in the long term use. Verifying this claim by further studies can have an important role in reducing UTIs in patients using urinary catheters.

Management of lower urinary retention in a limited resource setting

BACKGROUND

There is a projected increase in lower urinary tract obstruction by 2018, especially in the developing economies of Asia and Africa. However in many of these countries, the problems encountered both by the patients and the clinicians are not well documented. Our aims are, to prospectively analyse the management of urinary retention, the associated difficulties, and complications in our setting, where access to investigative modalities such as Computerize Tomography and Magnetic Resonance Imaging are not available.

PATIENTS AND METHODS

The study was approved by the University Of Calabar Teaching Hospital ethical committee. A validated Proforma was used to collect data from all patients who were clinically diagnosed with urinary retention based on history, and physical examination, from July 2009 to June 2010. Data collected from the 1st of July 2009 to the 30th of June 2010, include demographics, findings on physical examination, previous medical history and co-morbid conditions. The results of investigations done such as: urinalysis, full blood count, electrolytes, urea and creatinine, intravenous urography, trans- abdominal ultrasonography, chest X-ray and histology of trans-rectal biopsies of the prostate . The total number of new patients seen, including those with urinary retention during the study was documented. The retentions were also classified into acute and chronic. All the patients were followed up throughout the study. The data was analysed using Epi-Info statistical program version 3.4 of 2007 to analyse the data, estimating averages, mean, median and percentages.

RESULTS

The total number of new patients seen, including those with urinary retention was Seventy thousand, one hundred and thirty nine (70,139).Of this number, hundred and fifty nine (0.23%), presented with urinary retention; 145 (91.2%) were acute, and14 (8.8%) were chronic. The male: female ratio was 39:1.The patients ages ranged from 4 to 94 years, with a mean of 53.7±11.2. Seventy seven [48.4%] of them were in the 6(th) and 7(th) decades of life. The common causes were; prostatic diseases [BPH and cancer of the prostate] 77.0%, infections 75.8%, trauma 12.1%, and congenital 12.1%. Urinary retention was relieved by: indwelling urethral catheterization [IUC] 120 patients (75.5%), supra- pubic cystostomy [SC] 34 (21.4%) and intermittent urethral catheterization [IC] 5 (3.1%). The most frequently encountered complications include pyuria (18.2%), pericatheter sepsis 17.5%, and haemorrhage during change of catheter 16.8% [figure 2]. Figure 2Complication after one week bladder drainage.

CONCLUSION

Lower urinary retention is common in our environment. The management is appropriate and standard. The man power and facilities are inadequate, and requires urgent improvement.

Safety of latex urinary catheters for the short time drainage

BACKGROUND

In this study, we attempt to identify the most appropriate catheter (silicone vs. latex) for short-term urinary catheterization. We compared the post-operative clinico-pathological complications between latex and silicone for short term catheterization in rabbits with hypospadias.

MATERIALS AND METHODS

Forty rabbits were used in our study to compare complications of catheterization. They were divided in two groups. Hypospadias like defect was created by a 1 cm long excision of the ventral urethra. For urethroplasty, we used tubularized incised plate technique. Latex and silicon catheters were used in groups 1 and 2, respectively. Post-operatively, routine laboratory urine test and complications (allergy, infection, bleeding) were compared in groups.

RESULTS

A total of 40 rabbits underwent hypospadias repair. Findings showed that there were no significant differences between groups based on urine test indices (P = NS). Urinary tract infection rate was 10% (2 rabbits) in latex and 0% in silicone groups (P = NS). There were no significant differences between groups regarding of cystitis grades between study groups (P = NS).

CONCLUSION

It seems that urinary tract catheterization with latex catheters is a safe, feasible, and in-expensive procedure for short-term post-operative course in hypospadias surgery in patients without latex hypersensitivity.

Solidago, orthosiphon, birch and cranberry extracts can decrease microbial colonization and biofilm development in indwelling urinary catheter: a microbiologic and ultrastructural pilot study

PURPOSE

Plants extracts are used in urology to manage urinary tract infections. We aimed to evaluate the efficacy of a preparation with solidago, orthosiphon, birch and cranberry extracts (CISTIMEV PLUS(®)) in reducing microbial colonization and biofilm development in patients with indwelling urinary catheters.

METHODS

All consecutive outpatients attending our department between January and June 2010 for the substitution of indwelling catheters were considered for this single-blinded, randomized and controlled pilot study to test superiority of the preventative management (CISTIMEV PLUS(®), 1 tablet daily for 30 days) in respect to no treatment. A sample size of 10-40 participants per group was considered adequate. All patients underwent urine culture the same day of the catheter substitution and were then randomized into test group (n = 48) and control group (n = 35). Ultrastructural analysis was also performed. After 30 days, the catheter was replaced and the analysis repeated. The primary outcome was the rate of positive urinary culture at the end of the entire study period.

RESULTS

Ten patients abandoned the study. At 30 days, according to per-protocol analysis, the groups statistically differed regarding the rate of positive urine cultures: test group 10/43 and control group 16/30 (p = 0.013) (-30.1 % [95 % CI -51.94 to -8.21]). The most common isolated bacteria were Escherichia coli and Enterococcus faecalis.

CONCLUSIONS

The use of solidago, orthosiphon, birch and cranberry extracts resulted in a significant reduction of microbial colonization in patients with indwelling urinary catheters. Larger clinical trials are needed to demonstrate that the effects here reported are sufficient to reduce symptomatic catheter-associated urinary tract infections.

A review of the biomaterials technologies for infection-resistant surfaces

Anti-infective biomaterials need to be tailored according to the specific clinical application. All their properties have to be tuned to achieve the best anti-infective performance together with safe biocompatibility and appropriate tissue interactions. Innovative technologies are developing new biomaterials and surfaces endowed with anti-infective properties, relying either on antifouling, or bactericidal, or antibiofilm activities. This review aims at thoroughly surveying the numerous classes of antibacterial biomaterials and the underlying strategies behind them. Bacteria repelling and antiadhesive surfaces, materials with intrinsic antibacterial properties, antibacterial coatings, nanostructured materials, and molecules interfering with bacterial biofilm are considered. Among the new strategies, the use of phages or of antisense peptide nucleic acids are discussed, as well as the possibility to modulate the local immune response by active cytokines. Overall, there is a wealth of technical solutions to contrast the establishment of an implant infection. Many of them exhibit a great potential in preclinical models. The lack of well-structured prospective multicenter clinical trials hinders the achievement of conclusive data on the efficacy and comparative performance of anti-infective biomaterials.

Infection control in severely burned patients

In the last two decades, much progress has been made in the control of burn wound infection and nasocomial infections (NI) in severely burned patients. The continiually changing epidemiology is partially related to greater understanding of and improved techniques for burn patient management as well as effective hospital infection control measures. With the advent of antimicrobial chemotherapeutic agents, infection of the wound site is now not as common as, for example, urinary and blood stream infections. Universal application of early excision of burned tissues has made a substantial improvement in the control of wound-related infections in burns. Additionally, the development of new technologies in wound care have helped to decrease morbidity and mortality in severe burn victims. Many examples can be given of the successful control of wound infection, such as the application of an appropriate antibiotic solution to invasive wound infection sites with simultaneous vacuum-assisted closure, optimal preservation of viable tissues with waterjet debridement systems, edema and exudate controlling dressings impregnated with Ag (Silvercel, Aquacell-Ag). The burned patient is at high risk for NI. Invasive interventions including intravenous and urinary chateterization, and entubation pose a further risk of NIs. The use of newly designed antimicrobial impregnated chateters or silicone devices may help the control of infection in these immunocomprimised patients. Strict infection control practices (physical isolation in a private room, use of gloves and gowns during patient contact) and appropriate empirical antimicrobial therapy guided by laboratory surveillance culture as well as routine microbial burn wound culture are essential to help reduce the incidance of infections due to antibiotic resistant microorganisms.

Post-operative care following primary optical urethrotomy: towards an evidence based approach

Introduction:

Optical urethrotomy (OU) is the commonest procedure performed for primary bulbar urethral strictures. Recurrence rates of up to 50% are reported, but data is lacking on the influence of post-operative management regimes on patient’s outcomes. The aim of this study was to quantify the variation in treatment approaches within a region and determine from the literature what constitutes best practice.

Methods:

A survey regarding post-operative management following OU was sent to urologists in the Yorkshire Deanery. The questions related to post-operative catheter usage, intermittent self dilatation (ISD) regimes and follow-up investigations. A literature review regarding these aspects of post-operative care was subsequently performed.

Results:

Questionnaires were sent to 70 urologists, of which 42 urologists replied. All respondents insert a urethral catheter following OU. Two thirds of respondents advise patients to perform ISD but one third of those advise continuing for only 6 months. Uroflowmetry and post micturition residual estimation are the mainstay of follow up investigations.

Conclusions:

The practice in our region largely reflects the best available evidence. The literature suggests that catheter size/material has no effect on outcome. Catheter duration should be for less than 3 days due to increased risk of recurrence. ISD should be performed for at least one year as this is associated with significantly lower recurrence rates than 6 months treatment. Urethrography is more accurate than uroflowmetery for follow up but results must be correlated with patient symptoms.

Reduction of catheter-associated urinary tract infections among patients in a neurological intensive care unit: a single institution's success

OBJECT

To date, there has been a shortage of evidence-based quality improvement initiatives that have shown positive outcomes in the neurosurgical patient population. A single-institution prospective intervention trial with continuous feedback was conducted to investigate the implementation of a urinary tract infection (UTI) prevention bundle to decrease the catheter-associated UTI rate.

METHODS

All patients admitted to the adult neurological intensive care unit (neuro ICU) during a 30-month period were included. The study consisted of two 1-month preintervention observation periods (approximately 1200 catheter days) followed by a 30-month intervention phase (20,394 catheter days). A comprehensive evidence-based UTI bundle encompassing avoidance of catheter insertion, maintenance of sterility, product standardization, and early catheter removal was enacted.

RESULTS

The urinary catheter utilization rate dropped from 100% to 73.3% during the intervention phase (p < 0.0001) without any increase in the rate of sacral decubitus ulcers or other skin breakdown. The rate of catheter-associated UTI was also significantly reduced from 13.3 to 4.0 infections per 1000 catheter days (p < 0.001). There was a linear relationship between the decreased quarterly catheter utilization rate and the decreased catheter-associated UTI rate (r(2) = 0.79, p < 0.0001).

CONCLUSIONS

This single-center prospective study demonstrated that a comprehensive UTI prevention bundle along with a continuous quality improvement program can significantly reduce the duration of urinary catheterization and rate of catheter-associated UTI in a neuro ICU.

Safer urethral catheters: how study of catheter balloon pressure and force can guide design

OBJECTIVES

To better define urethral catheter balloon pressures and extraction forces during traumatic placement and removal of urethral catheters. To help guide design for safer urethral catheters.

MATERIALS AND METHODS

Measurements of balloon pressure were made upon filling within the urethra vs the bladder. Extraction forces were measured upon removal of a catheter with a filled balloon from the bladder. Models for the bladder and urethra included an ex vivo model (funnel, 'bladder', attached to a 30 F tube, 'urethra') and fresh human male cadavers. The mean (SEM) balloon pressures and extraction forces were calculated.

RESULTS

In the ex vivo model, the mean (SEM) pressures upon filling the balloon with 10 mL were on average three-times higher within the ex vivo'urethra' (177 [6] kPa) vs 'bladder' (59 [2] kPa) across multiple catheter types. In the human cadaver, the mean balloon pressure was 1.9-times higher within the urethra (139 [11] kPa) vs bladder (68 [4] kPa). Balloon pressure increased non-linearly during intraurethral filling of both models, resulting in either balloon rupture (silicone catheters) or 'ballooning' of the neck of the balloon filling port (latex catheters). Removal of a filled balloon per the ex vivo model 'urethra' and cadaveric urethra, similarly required increasing force with greater balloon fill volumes (e.g. 9.34 [0.44] N for 5 mL vs 41.37 [8.01] N for 10 mL balloon volume).

CONCLUSIONS

Iatrogenic complications from improper urethral catheter use is common. Catheter balloon pressures and manual extraction forces associated with urethral injury are significantly greater than those found with normal use. The differences in pressure and force may be incorporated into a safer urethral catheter design, which may significantly reduce iatrogenic urethral injury associated with catheterization.

Nasal cytology: the "infectious spot", an expression of a morphological-chromatic biofilm

The purpose of this study was to describe some "morphological-chromatic" patterns (i.e. spots of cyan colour) identified during the study of nasal cytology in patients with both bacterial and fungal infectious rhinological disorders. These peculiar aspects strongly suggest the presence of a microscopic biofilm. We retrospectively examined 1,410 nasal cytology specimens from subjects who underwent clinical-instrumental investigations (history, ENT visit, nasal endoscopy and nasal cytology) from January to August 2010. The control samples were represented by 30 subjects not suffering from infectious rhinological diseases. The presence of particular spots of "cyan" was found in colour in 107/1,410 rhinocytograms (7.6%), within which bacterial colonies and/or fungal spores were found. We called these coloured spot formations "infectious spots" (IS). The positivity to periodic acid Schiff (PAS) staining confirmed the polysaccharide nature of the coloured spots and allowed us to relate them to biofilms. This study demonstrates, for the first time, that nasal cytology performed by optical microscope can play an important role in detecting biofilms.

Bladder catheterization in Greek nursing education: An audit of the skills taught

INTRODUCTION

The auditing of nurse teaching is in its infancy in Greece. One area urgently in need of audit is the teaching of male catheterization.

AIMS

To assess the current educational model regarding male bladder catheterization at a sole tertiary education nursing establishment in a major Greek city and to improve nurse undergraduate training by implementing appropriate recommendations for change to the current educational module and support these changes in the long term.

METHODS

A systematic search of international databases for guidelines or best practice regarding bladder catheterization was conducted. Audit measures included direct observation of the teaching process and compilation of a checklist.

RESULTS

The shortcomings are discussed under the following headings: patient pre-preparation, choice and quality of materials used, appropriate aseptic techniques, catheter withdrawal, connecting and handling the drainage bag, diminishing risk of Catheter Associated Urinary Track Infections (CAUTIs), no problem solving trouble-shooting training, textbook and educational resources, lack of national guidelines, setting of the educational experience.

CONCLUSIONS

The main problem with the teaching process exposed by the audit is entrenched use of an outmoded textbook with little effort to enrich teaching with current evidence base practices.