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Bouassida K, Marzouk M, Nouir S, Ghammem R, Sahtout W, Ghardallou M, Fathallah N, Boukadida J, Jaidane M, Slim R, Zaïri A. Analysis of Pathogens of Urinary Tract Infections Associated with Indwelling Double-J Stents and Their Susceptibility to Globularia alypum. Pharmaceutics 2023; 15:2496. [PMID: 37896256 PMCID: PMC10609942 DOI: 10.3390/pharmaceutics15102496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Ureteral double-J stents are frequently used to prevent urinary obstruction. They can develop bacterial colonization and encrustation, which leads to persistent infections that seldom respond to antibiotic treatment. Thus, the goal of this study was to evaluate the local spectrum of bacterial pathogens and their susceptibility to natural compounds. A total of 59 double-J ureteral stents from 59 consecutive patients were examined. The samples were inoculated on agar culture mediums. Extracts of Globularia alypum L. were evaluated for their antibacterial activity with the diffusion and broth dilution methods; for antibiofilm activity, the crystal violet assay was used. The identification and the quantification of the different constituents of extracts were determined by reverse-phase high-performance liquid chromatography (RP-HPLC). Bacterial growth was found in three patients (5.1%). Enterococcus faecalis (1.7%), Acinetobacter baumanii (1.7%), and Pseudomonas putida (1.7%) strains were more commonly detected. They were resistant to several common antibiotics. All extracts presented several components, mainly nepetin-7-glucoside and trans-ferulic-acid, and they had antibacterial activity (MIC = 6.25 mg/mL and MBC = 6.25 mg/mL), and antibiofilm (59.70% at 25 mg/mL) properties, especially against Acinetobacter baumanii. The results achieved confirm the important role of this plant as a source of therapeutic activities.
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Affiliation(s)
| | - Manel Marzouk
- Laboratory of Microbiology, Hospital Farhat Hached, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia; (M.M.); (J.B.)
| | - Sahar Nouir
- Laboratory of Biochemistry, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia;
| | - Rim Ghammem
- Department of Epidemiology and Preventive Medicine, University of Sousse, Sousse 4002, Tunisia;
| | - Wissal Sahtout
- Nephrology Department, Sahloul Hospital, Sousse 4054, Tunisia;
| | - Meriam Ghardallou
- Department of Community Medicine, Research Laboratory LR12ES03, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia;
| | - Neila Fathallah
- Department of Clinical Pharmacology, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia; (N.F.); (R.S.)
| | - Jalel Boukadida
- Laboratory of Microbiology, Hospital Farhat Hached, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia; (M.M.); (J.B.)
| | - Mehdi Jaidane
- Urology Department, Sahloul Hospital, Sousse 4054, Tunisia; (K.B.); (M.J.)
| | - Raoudha Slim
- Department of Clinical Pharmacology, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia; (N.F.); (R.S.)
| | - Amira Zaïri
- Laboratory of Biochemistry, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia;
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Bacterial Colonization Incidence before and after Indwelling Double-J Ureteral Stents. Antibiotics (Basel) 2022; 11:antibiotics11070850. [PMID: 35884104 PMCID: PMC9312341 DOI: 10.3390/antibiotics11070850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 02/01/2023] Open
Abstract
The upper urinary tract stenting allows to restore the ureteral patency in various situations. However, one of the main disadvantages of stenting is bacterial contamination, which can be a source of persistent infections that hardly respond to antibiotic therapy. The aim of this study was to investigate the local spectrum of bacterial pathogens and their susceptibility to antibiotics in order to optimize antibacterial therapy after upper urinary tract stenting. A prospective observational study was conducted in which 140 urine samples were examined (70 before stenting and 70 after stenting). Bacterial growth was detected in 37 patients (52.8%) before stenting and in 43 patients (61.4%) after stenting. E. coli (13 (28.8%)) and Streptococcus spp. (8 (17.6%)) strains were more commonly detected before stenting; P. aeruginosa (15 (31.2%)) and E. coli (8 (16.6%)) were usually revealed after stenting. The proportion of P. aeruginosa strains after stenting grew from 4.4% up to 31.2%. E. coli strains were resistant to ampicillin (92.3% before and 100% after stenting). Three strains of E. coli (23.1%) and six strains of P. aeruginosa (40%) were multidrug-resistant. Determination of the bacterial sensitivity to antibiotics and identification of antibiotic-resistant forms of bacteria is a factor in reducing the risk of complications and optimizing antibiotic therapy during the upper urinary tract stenting.
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Pinto RM, Lopes-de-Campos D, Martins MCL, Van Dijck P, Nunes C, Reis S. Impact of nanosystems in Staphylococcus aureus biofilms treatment. FEMS Microbiol Rev 2020; 43:622-641. [PMID: 31420962 PMCID: PMC8038934 DOI: 10.1093/femsre/fuz021] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 08/15/2019] [Indexed: 12/17/2022] Open
Abstract
Staphylococcus aureus (S. aureus) is considered by the World Health Organization as a high priority pathogen for which new therapies are needed. This is particularly important for biofilm implant-associated infections once the only available treatment option implies a surgical procedure combined with antibiotic therapy. Consequently, these infections represent an economic burden for Healthcare Systems. A new strategy has emerged to tackle this problem: for small bugs, small particles. Here, we describe how nanotechnology-based systems have been studied to treat S. aureus biofilms. Their features, drawbacks and potentialities to impact the treatment of these infections are highlighted. Furthermore, we also outline biofilm models and assays required for preclinical validation of those nanosystems to smooth the process of clinical translation.
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Affiliation(s)
- Rita M Pinto
- LAQV, REQUIMTE, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.,Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, B-3001 Leuven, Belgium.,VIB-KU Leuven, Center for Microbiology, B-3001 Leuven, Belgium.,i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto; INEB, Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal
| | - Daniela Lopes-de-Campos
- LAQV, REQUIMTE, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - M Cristina L Martins
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto; INEB, Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal.,ICBAS, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Patrick Van Dijck
- Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, B-3001 Leuven, Belgium.,VIB-KU Leuven, Center for Microbiology, B-3001 Leuven, Belgium
| | - Cláudia Nunes
- LAQV, REQUIMTE, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Salette Reis
- LAQV, REQUIMTE, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
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Yin K, Divakar P, Wegst UGK. Freeze-casting porous chitosan ureteral stents for improved drainage. Acta Biomater 2019; 84:231-241. [PMID: 30414484 PMCID: PMC6864386 DOI: 10.1016/j.actbio.2018.11.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 02/05/2023]
Abstract
As a new strategy for improved urinary drainage, in parallel to the potential for additional functions such as drug release and self-removal, highly porous chitosan stents are manufactured by radial, bi-directional freeze-casting. Inserting the porous stent in to a silicone tube to emulate its placement in the ureter shows that it is shape conforming and remains safely positioned in place, also during flow tests, including those performed in a peristaltic pump. Cyclic compression tests on fully-hydrated porous stents reveal high stent resilience and close to full elastic recovery upon unloading. The drainage performance of the chitosan stent is evaluated, using effective viscosity in addition to volumetric flow and flux; the porous stent's performance is compared to that of the straight portion of a commercial 8 Fr double-J stent which possesses, in its otherwise solid tube wall, regularly spaced holes along its length. Both the porous and the 8 Fr stent show higher effective viscosities, when tested in the silicone tube. The performance of the porous stent improves considerably more (47.5%) than that of the 8 Fr stent (30.6%) upon removal from the tube, illustrating the effectiveness of the radially aligned porosity for drainage. We conclude that the newly-developed porous chitosan ureteral stent merits further in vitro and in vivo assessment of its promise as an alternative and complement to currently available medical devices. STATEMENT OF SIGNIFICANCE: No papers, to date, report on porous ureteral stents, which we propose as a new strategy for improved urinary drainage. The highly porous chitosan stents of our study are manufactured by radial, bi-directional freeze casting. Cyclic compression tests on fully-hydrated porous stents revealed high stent resilience and close to full recovery upon unloading. The drainage performance of the chitosan is evaluated, using effective viscosity in addition to volumetric flow and flux, and compared to that of the straight portion of a commercial 8 Fr double-J stent. The performance of the porous stent improves considerably more (47.5%) than that of the 8 Fr stent (30.6%) upon removal from the tube, illustrating the effectiveness of the radially aligned porosity for drainage. While further studies are required to explore other potential benefits of the porous stent design such as antimicrobial behavior, drug release, and biodegradability, we conclude that the newly-developed porous chitosan ureteral stent has considerable potential as a medical device.
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Affiliation(s)
- Kaiyang Yin
- Thayer School of Engineering, Dartmouth College, 14 Engineering Dr, Hanover, NH 03755, USA
| | - Prajan Divakar
- Thayer School of Engineering, Dartmouth College, 14 Engineering Dr, Hanover, NH 03755, USA
| | - Ulrike G K Wegst
- Thayer School of Engineering, Dartmouth College, 14 Engineering Dr, Hanover, NH 03755, USA.
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Kang TW, Chandrasekaran G, Hwang EC, Kim HS, Lakshmanan VK. Characterization and antibacterial activity of PVA–PVP–CS carvacrol-loaded polymer composite films for urinary catheter. INT J POLYM MATER PO 2018. [DOI: 10.1080/00914037.2017.1417286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Taek Won Kang
- Department of Urology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | | | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hye Su Kim
- Premedical Sciences, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Vinoth-Kumar Lakshmanan
- Department of Biomedical Sciences, Chonnam National University Medical School, Gwangju, Republic of Korea
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Betschart P, Zumstein V, Piller A, Schmid HP, Abt D. Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic review. Int J Urol 2017; 24:250-259. [DOI: 10.1111/iju.13311] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/11/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Patrick Betschart
- Department of Urology; St. Gallen Cantonal Hospital; St. Gallen Switzerland
| | - Valentin Zumstein
- Department of Urology; St. Gallen Cantonal Hospital; St. Gallen Switzerland
| | - Alberto Piller
- Department of Urology; St. Gallen Cantonal Hospital; St. Gallen Switzerland
| | - Hans-Peter Schmid
- Department of Urology; St. Gallen Cantonal Hospital; St. Gallen Switzerland
| | - Dominik Abt
- Department of Urology; St. Gallen Cantonal Hospital; St. Gallen Switzerland
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Buhmann MT, Stiefel P, Maniura-Weber K, Ren Q. In Vitro Biofilm Models for Device-Related Infections. Trends Biotechnol 2016; 34:945-948. [DOI: 10.1016/j.tibtech.2016.05.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
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Abstract
PURPOSE OF REVIEW We review new therapies and biomaterials designed to reduce ureteral stent symptoms in patients undergoing ureteroscopy. RECENT FINDINGS Pharmacologically, alpha blockers and antimuscarinics have been shown to have a synergistic effect and be more effective than either medication alone in reducing stent-related symptoms. Prestenting patients prior to ureterosocpy has been shown to be beneficial for patients with renal stones, offering a better stone-free rate and reduced complications, but not for ureteral stones. Stenting after use of a ureteral access sheath reduced complications and unscheduled emergency visits. Nonsteroidal anti-inflammatories have been shown to prevent pain after stent removal. Surveys showed that patients preferred to remove their own stents via dangle strings at home or undergo cystoscopic removal in the operating room with some type of anesthesia. New materials such as gel-based or biodegradable ureteral stents are being developed to deal with stent-related pain, encrustation, and infection. Antirefluxing stents eliminate vesicoureteric reflux in patients during voiding and may reduce symptoms of back and flank pain. Ureteral stents are involved in many procedures in urology and particularly kidney stone treatments. SUMMARY Advances in materials and medications will help improve the patient experience for those who receive a ureteral stent.
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Abstract
Ureteral stents are commonly used in urology. Every urologist is familiar with the problems that are associated with stents including infection, encrustation, and bothersome symptoms. These problems limit and affect the use of ureteral stents which are necessary, even in light of the problems they can cause. New designs such as a helically cut ureteral stent which is designed to stretch and conform to the ureter is designed to improve comfort. Drug-eluting designs with an antimicrobial (triclosan) are designed to reduce bacterial adherence to ureteral stents. Chlorhexidine, an antiseptic, has been incorporated into a stent and held in place by a slow release varnish to prevent biofilm formation. Combinations of antibiotics coated directly on the stent and administered systemically have been shown to reduce stent colonization both in vitro and in vivo. Gel-based ureteral stents were also showed to reduce bacterial infection and colonization. Bioabsorbable materials have also been designed to reduce infection, symptoms and prevent the forgotten stent syndrome. Newer designs including stents based on guidewire technology, gels, and a combination of self-expanding wire stents with polymer films are reviewed. There is hope on the horizon that new stents will be able to effectively tackle problems that are often seen with ureteral stents.
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Affiliation(s)
- Hilary Brotherhood
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Dirk Lange
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
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Novel Strategy for Temporary Decompression of the Lower Urinary Tract in Neonates Using a Ureteral Stent. J Urol 2015; 194:1086-90. [DOI: 10.1016/j.juro.2015.04.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/21/2022]
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