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Drake MJ, Clavica F, Murphy C, Fader MJ. Innovating Indwelling Catheter Design to Counteract Urinary Tract Infection. Eur Urol Focus 2024:S2405-4569(24)00184-6. [PMID: 39341718 DOI: 10.1016/j.euf.2024.09.015] [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: 07/10/2024] [Revised: 09/08/2024] [Accepted: 09/20/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Bacteriuria is anticipated in long-term indwelling catheter (IDC) use, and urinary tract infections (UTIs) and related issues are common. Defence mechanisms against infection are undermined by the presence of a Foley catheter, and adjustments to design could influence UTI risk. METHODS We reviewed the various aspects of IDCs and ureteric stent designs to discuss potential impact on UTI risk. KEY FINDINGS AND LIMITATIONS Design adaptations have focussed on reducing the sump of undrained urine, potential urinary tract trauma, and bacterial adherence. Experimental and computational studies on ureteral stents found an interplay between urine flow, bacterial microcolony formation, and accumulation of encrusting particles. The most critical regions for biofilm and crystal accumulation are associated with low shear stress. The full drainage system is the functioning unit, not just the IDC in isolation. This means reliably keeping the drainage system closed and considering whether a valve is preferred to a collection bag. Other developments may include one-way valves, obstacles to "bacterial swimming", and ultrasound techniques. Preventing or clearing IDC blockage can exploit access via the lumen or retaining balloon. Progress in computational fluid dynamics, energy delivery, and soft robotics may increase future options. Clinical data on the effectiveness of IDC design features are lacking, which is partly due to reliance on proxy measures and the challenges of undertaking trials. CONCLUSIONS AND CLINICAL IMPLICATIONS Design changes are legitimate lines of development, but are only indirect for UTI prevention. Modifications may be advantageous, but might potentially bring problems in other ways. Education of health care professionals can improve UTIs and should be prioritised. PATIENT SUMMARY Catheters used to help bladder drainage can cause urinary infections, and improvements in design might reduce the risk. Several approaches are described in this review. However, proving that these approaches work is a challenge. Training professionals in the key aspects of catheter care is important.
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Affiliation(s)
- Marcus J Drake
- Department of Surgery and Cancer, Imperial College, London, UK; Department of Urology, Charing Cross Hospital, London, UK.
| | - Francesco Clavica
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cathy Murphy
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Mandy J Fader
- School of Health Sciences, University of Southampton, Southampton, UK
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Nissanka MC, Dilhari A, Wijesinghe GK, Weerasekera MM. Advances in experimental bladder models: bridging the gap between in vitro and in vivo approaches for investigating urinary tract infections. BMC Urol 2024; 24:206. [PMID: 39313789 PMCID: PMC11418205 DOI: 10.1186/s12894-024-01590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 09/06/2024] [Indexed: 09/25/2024] Open
Abstract
Urinary tract infections (UTIs) pose a substantial burden on global healthcare systems. When unraveling the complex pathophysiology of UTIs, bladder models are used to understand complex and multifaceted interactions between different components within the system. This review aimed to bridge the gap between in vitro and in vivo experimental bladder models towards UTI research. We reviewed clinical, animal, and analytical studies and patents from 1959 to the end of 2023. Both in vivo and in vitro models offer unique benefits and drawbacks in understanding UTIs. In vitro models provide controlled environments for studying specific aspects of UTI biology and testing potential treatments, while in vivo models offer insights into how UTIs manifest and progress within living organisms. Thus, both types of models are leading to the development of more effective diagnostic tools and therapeutic interventions against UTIs. Moreover, advanced methodologies involving three-dimensional bladder organoids have also been used to study bladder biology, model bladder-related disorders, and explore new treatments for bladder cancers, UTIs, and urinary incontinence. Narrowing the distance between fundamental scientific research and practical medical applications, these pioneering models hold the key to unlocking new avenues for the development of personalized diagnostics, precision medicine, and ultimately, the alleviation of UTI-related morbidity worldwide.
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Affiliation(s)
| | - Ayomi Dilhari
- Department of Basic Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| | | | - Manjula Manoji Weerasekera
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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Heylen RA, Cusick N, White T, Owen EJ, Patenall BL, Alm M, Thomsen P, Laabei M, Jenkins ATA. Rational design and in vitro testing of new urease inhibitors to prevent urinary catheter blockage. RSC Med Chem 2024:d4md00378k. [PMID: 39281800 PMCID: PMC11391341 DOI: 10.1039/d4md00378k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/31/2024] [Indexed: 09/18/2024] Open
Abstract
Catheter associated urinary tract infections (CAUTI) caused by urease-positive organisms can lead to catheter blockage: urease metabolizes urea in urine to ammonia causing an increase in pH and hence precipitation of struvite and apatite salts into the catheter lumen and bladder leading to blockage. Acetohydroxamic acid (AHA) is the only urease inhibitor currently approved for patient use, however, it is rarely used owing to its side effects. Here, we report the identification and development of new urease inhibitors discovered using a rational in silico drug design approach. A series of compounds were designed, the compounds were screened and filtered to identify three compounds which were tested in in vitro urease activity assays. N,N'-Bis(3-pyridinylmethyl)thiourea (Bis-TU) outperformed AHA in activity assays and was tested in an in vitro bladder model, where it significantly extended the lifetime of the catheter compared to AHA. Bis-TU was delivered via a diffusible balloon catheter directly to the site of activity, thus demonstrating localized drug delivery. This cost-effective drug design approach allowed the identification of a potent urease inhibitor, which could be improved through iterative repeats of the method, and the process of design could be utilized to target other diseases.
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Affiliation(s)
| | - Nicola Cusick
- Department of Chemistry, University of Bath Bath BA2 7AY UK
| | - Tom White
- Department of Chemistry, University of Bath Bath BA2 7AY UK
| | - Emily J Owen
- Department of Chemistry, University of Bath Bath BA2 7AY UK
| | | | - Martin Alm
- Biomodics ApS Fjeldhammervej 15 2610 Rødovre Denmark
| | - Peter Thomsen
- Biomodics ApS Fjeldhammervej 15 2610 Rødovre Denmark
| | - Maisem Laabei
- School of Cellular and Molecular Medicine, University of Bristol BS8 1TD Bristol UK
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Aust AC, Weigel M, Herrmann JP, Shevchuk O, Robert Engel D, Dobrindt U, Hain T, Wagenlehner F. Influence of Kidney Environment Parameters on Antibiotic Efficacy Against Uropathogenic Escherichia coli. Eur Urol Focus 2024:S2405-4569(24)00127-5. [PMID: 39089966 DOI: 10.1016/j.euf.2024.07.007] [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: 06/20/2024] [Accepted: 07/12/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND AND OBJECTIVE Urinary tract infections (UTIs) are common infections affecting the urinary system, predominantly caused by bacterial pathogens, with Escherichia coli being the most frequent pathogen. Infections of the kidney (eg, pyelonephritis) are severe and challenging to treat, due to the specific tissue microenvironment. In this study, the influence of different parameters mimicking the kidney environment on the effectiveness of antibiotics prescribed for pyelonephritis on the growth of uropathogenic strains was analyzed. METHODS To investigate the influence of different factors mimicking the kidney environment, we tested the effect of different kidney-representative concentrations of sodium chloride and urea, and different pH values on the efficacy of ertapenem, levofloxacin, and ceftriaxone. The effectiveness was assessed by determining the minimal inhibitory concentrations (MICs) against various E. coli strains. KEY FINDINGS AND LIMITATIONS The study revealed that pH significantly influences the MIC values of levofloxacin. Acidification of the pH led to an increase of the MIC values, while an alkaline pH had the opposite effect. The influence of sodium chloride and urea concentrations was strain and antibiotic specific. Since three different antibiotics were tested in this study, further research with additional antibiotics is warranted. CONCLUSIONS AND CLINICAL IMPLICATIONS These results suggest that the physicochemical conditions within the kidney can substantially influence the success of antibiotic therapy for pyelonephritis. Therefore, it is crucial for clinicians to consider these factors when selecting and dosing antibiotics. Further research is needed to evaluate a broader range of antibiotics and additional environmental parameters, to develop a more comprehensive understanding of how the kidney environment affects antimicrobial activity. This knowledge will be vital in optimizing treatment strategies for pyelonephritis, ultimately improving patient outcomes. PATIENT SUMMARY The physicochemical conditions within the kidney influence the success of antibiotic therapy for pyelonephritis. Our findings are vital in optimizing treatment strategies and will ultimately improve patient outcomes.
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Affiliation(s)
- Anne-Christine Aust
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University of Giessen, Giessen, Germany.
| | - Markus Weigel
- Institute of Medical Microbiology, Medical Microbiome - Metagenome Unit (M3U), Justus Liebig University Giessen, Giessen, Germany; German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, Giessen, Germany
| | - Jan-Paul Herrmann
- Institute of Medical Microbiology, Medical Microbiome - Metagenome Unit (M3U), Justus Liebig University Giessen, Giessen, Germany
| | - Olga Shevchuk
- Institute for Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Daniel Robert Engel
- Institute for Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Ulrich Dobrindt
- Institute of Hygiene, University of Münster, Münster, Germany
| | - Torsten Hain
- Institute of Medical Microbiology, Medical Microbiome - Metagenome Unit (M3U), Justus Liebig University Giessen, Giessen, Germany; German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, Giessen, Germany
| | - Florian Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University of Giessen, Giessen, Germany; German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, Giessen, Germany
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Pelling H, Bennett V, Bock LJ, Wand ME, Denham EL, MacFarlane WM, Sutton JM, Jones BV. Identification of mechanisms modulating chlorhexidine and octenidine susceptibility in Proteus mirabilis. J Appl Microbiol 2024; 135:lxae173. [PMID: 38991984 DOI: 10.1093/jambio/lxae173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/20/2024] [Accepted: 07/10/2024] [Indexed: 07/13/2024]
Abstract
AIMS We aimed to identify mechanisms underlying the tolerance of Proteus mirabilis-a common cause of catheter associated urinary tract infection-to the clinically used biocides chlorhexidine (CHD) and octenidine (OCT). METHODS AND RESULTS We adapted three clinical isolates to grow at concentrations of 512 µg ml-1 CHD and 128 µg ml-1 OCT. Genetic characterization and complementation studies revealed mutations inactivating the smvR repressor and increasing smvA efflux expression were associated with adaptation to both biocides. Mutations in mipA (encoding the MltA interacting protein) were less prevalent than smvR mutations and only identified in CHD adapted populations. Mutations in the rppA response regulator were exclusive to one adapted isolate and were linked with reduced polymyxin B susceptibility and a predicted gain of function after biocide adaptation. Biocide adaptation had no impact on crystalline biofilm formation. CONCLUSIONS SmvR inactivation is a key mechanism in both CHD and OCT tolerance. MipA inactivation alone confers moderate protection against CHD, and rppA showed no direct role in either CHD or OCT susceptibility.
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Affiliation(s)
- Harriet Pelling
- Department of Life Sciences, University of Bath, Bath BA2 7AY, United Kingdom
- School of Applied Sciences, University of Brighton, Brighton BN2 4GJ, United Kingdom
| | - Vicky Bennett
- Department of Life Sciences, University of Bath, Bath BA2 7AY, United Kingdom
| | - Lucy J Bock
- United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Matthew E Wand
- United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Emma L Denham
- Department of Life Sciences, University of Bath, Bath BA2 7AY, United Kingdom
| | - Wendy M MacFarlane
- School of Applied Sciences, University of Brighton, Brighton BN2 4GJ, United Kingdom
| | - J Mark Sutton
- United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Brian V Jones
- Department of Life Sciences, University of Bath, Bath BA2 7AY, United Kingdom
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6
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Moore JV, Burns J, McClelland N, Quinn J, McCoy CP. Understanding the properties of intermittent catheters to inform future development. Proc Inst Mech Eng H 2024; 238:713-727. [PMID: 37300485 PMCID: PMC11318220 DOI: 10.1177/09544119231178468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/10/2023] [Indexed: 06/12/2023]
Abstract
Despite the extensive use of intermittent catheters (ICs) in healthcare, various issues persist for long-term IC users, such as pain, discomfort, infection, and tissue damage, including strictures, scarring and micro-abrasions. A lubricous IC surface is considered necessary to reduce patient pain and trauma, and therefore is a primary focus of IC development to improve patient comfort. While an important consideration, other factors should be routinely investigated to inform future IC development. An array of in vitro tests should be employed to assess IC's lubricity, biocompatibility and the risk of urinary tract infection development associated with their use. Herein, we highlight the importance of current in vitro characterisation techniques, the demand for optimisation and an unmet need to develop a universal 'toolkit' to assess IC properties.
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Affiliation(s)
| | | | | | | | - Colin P McCoy
- School of Pharmacy, Queen’s University Belfast, Belfast, Northern Ireland, UK
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7
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Walsh D, Bevan J, Harrison F. How Does Airway Surface Liquid Composition Vary in Different Pulmonary Diseases, and How Can We Use This Knowledge to Model Microbial Infections? Microorganisms 2024; 12:732. [PMID: 38674677 PMCID: PMC11052052 DOI: 10.3390/microorganisms12040732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Growth environment greatly alters many facets of pathogen physiology, including pathogenesis and antimicrobial tolerance. The importance of host-mimicking environments for attaining an accurate picture of pathogen behaviour is widely recognised. Whilst this recognition has translated into the extensive development of artificial cystic fibrosis (CF) sputum medium, attempts to mimic the growth environment in other respiratory disease states have been completely neglected. The composition of the airway surface liquid (ASL) in different pulmonary diseases is far less well characterised than CF sputum, making it very difficult for researchers to model these infection environments. In this review, we discuss the components of human ASL, how different lung pathologies affect ASL composition, and how different pathogens interact with these components. This will provide researchers interested in mimicking different respiratory environments with the information necessary to design a host-mimicking medium, allowing for better understanding of how to treat pathogens causing infection in these environments.
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Affiliation(s)
- Dean Walsh
- School of Life Sciences, University of Warwick, Coventry CV4 7AL, UK (F.H.)
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8
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Dean NL, Gras J, Lantz EE, Patterson JP, Inglese G, Goldstine JV, Medina-Rivera M, Bionda N, Strickland AD, Sileika TS. Microbial Transfer by Intermittent Catheters: An In Vitro Evaluation of Microbial Transfer in Catheter With Variable Protective Features. J Wound Ostomy Continence Nurs 2024; 51:66-73. [PMID: 38215300 DOI: 10.1097/won.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the effects of various protective features (eg, catheter cap, introducer tip, and catheter sleeve) of hydrophilic intermittent catheters against contamination with urinary tract infection-associated microorganisms using an in vitro model. DESIGN An in vitro study of microbial transfer. MATERIALS AND METHODS Gloves were contaminated with uropathogenic microorganisms and used to simulate intermittent catheterization of male anatomical models with and without the protective features present in 5 commercially available hydrophilic catheters. Using this contaminated touch transfer method, both the meatus of the sterile male anatomical models and sterile surgical gloves of an operator were inoculated with a high level of microorganisms (107 and 109 colony-forming units [CFU], respectively). The operator then performed catheterization of the anatomical model. The most relevant segments of the catheter were sampled, and the level of microbial transfer and catheter contamination was quantified. Results from experimental and sample replicates from the 3 microbial species and 5 catheters (sleeved and unsleeved) were analyzed by pair-wise t tests and analysis of variance. RESULTS Of the 5 commercially available sleeved intermittent catheters evaluated in this study, use of catheters with multiple protective components (ring cap, introducer tip, and catheter sleeve) resulted in significant improvement in protection against contamination with a 25- to 2500-fold lower level of microbial contamination (C1 segment) across all species as compared to catheters protected with only sleeves or un-sleeved catheters. CONCLUSIONS The combination of a ring cap, protective introducer tip, and protective sleeve provides additional protection when compared to sleeve alone from transferring microbial contamination from the meatus to the advancing catheter. Additional research is needed to determine whether these design features result in fewer urinary tract infections among intermittent catheter users.
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Affiliation(s)
- Nicole L Dean
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - James Gras
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Ellen E Lantz
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Jillian P Patterson
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Gary Inglese
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Jimena V Goldstine
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Mariely Medina-Rivera
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Nina Bionda
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Aaron D Strickland
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Tadas S Sileika
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
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9
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Drake MJ, Anderson K, Gammie A, Morris N, Timlin T, Cotterill N, Duff J, Fader M, Taylor H, Holmes R, Havard J. Development and first-in-human testing of FLUME urinary catheter with protected tip and relocated drainage holes. CONTINENCE (AMSTERDAM, NETHERLANDS) 2023; 8:None. [PMID: 38107022 PMCID: PMC10719115 DOI: 10.1016/j.cont.2023.101054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Purpose Evaluation of a catheter design which protects its tip with the retaining balloon when inflated, and has eyeholes at the base of the balloon to improve drainage. Materials and methods Preclinical tests included assessment of retaining balloon performance, and microbiological blockage. Clinical testing evaluated short-term use and safety in hospital (stage 1) or the patient's usual residence (stage 2). Results The retaining balloon supported static loads of 0.7kg, with reduced trauma when modelling forced evulsion. In vitro time to blockage with P. Mirabilis was significantly slower for FLUME compared with latex Foley catheters, but not the silicone Foley. Stage 1 testing (10 patients) confirmed balloon inflation, drainage, retention and removal, with no serious adverse events caused by catheterisation; one balloon failed to inflate, one patient could not be catheterised. Of five patients at stage 2, one had the catheter for 28 days without complication, one experienced spontaneous balloon deflation (14th day) and three needed early removal (blood clot, bypassing, difficulty connecting the drainage bag). Bacterial profiles of two FLUME catheters retained at least 2 weeks matched the Foley catheters. Acquired catheter colouration (two FLUME, one Foley) was not associated with biochemical change in the material. Conclusion FLUME catheter performed well in preclinical blockage and balloon tests. Tests in 15 patients confirmed basic function and additional training was not needed for staff familiar with Foley catheterisation. Clinical issues commonly seen with catheters included failed catheterisation, clot blockage and bypassing. In addition, an unintended balloon deflation and a failure of bag connection occurred. Plain language summary This article describes a new catheter design which aims to improve patient comfort and safety, and maximise bladder drainage, by protecting the bladder from the exposed catheter tip and by locating the drainage holes better. Various tests were done to check the catheter retaining balloon was safe and how well the catheter did when exposed to bacteria that could block it. The catheter was also used in people for the first time, to check it could be put in safely and functioned as intended. The results showed the FLUME catheter did well in the balloon and blockage tests. Tests in 15 patients confirmed basic function and showed placement was easy for staff familiar with conventional catheters. There were some clinical issues typical of urinary catheters and some possible improvements were identified.
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Affiliation(s)
- Marcus J. Drake
- Department of Surgery and Cancer, Imperial College, London, UK
| | | | - Andrew Gammie
- Bristol Urological Institute, North Bristol NHS trust, Bristol, UK
| | - Nicola Morris
- Bristol Urological Institute, North Bristol NHS trust, Bristol, UK
| | - Tony Timlin
- Research and Innovation, North Bristol NHS Trust, Bristol, UK
| | - Nikki Cotterill
- School for Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - John Duff
- Patient and Public Involvement, North Bristol NHS Trust, Bristol, UK
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10
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Manoharan A, Farrell J, Aldilla VR, Whiteley G, Kriel E, Glasbey T, Kumar N, Moore KH, Manos J, Das T. N-acetylcysteine prevents catheter occlusion and inflammation in catheter associated-urinary tract infections by suppressing urease activity. Front Cell Infect Microbiol 2023; 13:1216798. [PMID: 37965267 PMCID: PMC10641931 DOI: 10.3389/fcimb.2023.1216798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/19/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Proteus mirabilis is a key pathobiont in catheter-associated urinary tract infections (CA-UTIs), which is well known to form crystalline biofilms that occlude catheters. Urease activity alkylates urine through the release of ammonia, consequentially resulting in higher levels of Mg2+ and Ca2+ and formation of crystals. In this study, we showed that N-acetyl cysteine (NAC), a thiol antioxidant, is a potent urease inhibitor that prevents crystalline biofilm formation. Methods To quantify urease activity, Berthelot's method was done on bacterial extracts treated with NAC. We also used an in vitro catheterised glass bladder model to study the effect of NAC treatment on catheter occlusion and biofilm encrustation in P. mirabilis infections. Inductively-coupled plasma mass spectrometry (ICP-MS) was performed on catheter samples to decipher elemental profiles. Results NAC inhibits urease activity of clinical P. mirabilis isolates at concentrations as low as 1 mM, independent of bacterial killing. The study also showed that NAC is bacteriostatic on P. mirabilis, and inhibited biofilm formation and catheter occlusion in an in vitro. A significant 4-8log10 reduction in viable bacteria was observed in catheters infected in this model. Additionally, biofilms in NAC treated catheters displayed a depletion of calcium, magnesium, or phosphates (>10 fold reduction), thus confirming the absence of any urease activity in the presence of NAC. Interestingly, we also showed that not only is NAC anti-inflammatory in bladder epithelial cells (BECs), but that it mutes its inflammatory response to urease and P. mirabilis infection by reducing the production of IL-6, IL-8 and IL-1b. Discussion Using biochemical, microbiological and immunological techniques, this study displays the functionality of NAC in preventing catheter occlusion by inhibiting urease activity. The study also highlights NAC as a strong anti-inflammatory antibiofilm agent that can target both bacterial and host factors in the treatment of CA-UTIs.
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Affiliation(s)
- Arthika Manoharan
- Infection, Immunity and Inflammation Theme, School of Medical Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Institute of Infectious Disease, The University of Sydney, Sydney, NSW, Australia
| | - Jessica Farrell
- Infection, Immunity and Inflammation Theme, School of Medical Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Whiteley Corporation, Tomago, NSW, Australia
| | - Vina R. Aldilla
- School of Chemistry, The University of New South Wales, Sydney, NSW, Australia
| | - Greg Whiteley
- Infection, Immunity and Inflammation Theme, School of Medical Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Whiteley Corporation, Tomago, NSW, Australia
- School of Medicine, Western Sydney University, NSW, Australia
| | - Erik Kriel
- Whiteley Corporation, Tomago, NSW, Australia
| | | | - Naresh Kumar
- School of Chemistry, The University of New South Wales, Sydney, NSW, Australia
| | - Kate H. Moore
- Department of Urogynaecology, St George Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Jim Manos
- Infection, Immunity and Inflammation Theme, School of Medical Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Institute of Infectious Disease, The University of Sydney, Sydney, NSW, Australia
| | - Theerthankar Das
- Infection, Immunity and Inflammation Theme, School of Medical Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Institute of Infectious Disease, The University of Sydney, Sydney, NSW, Australia
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11
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Alhagi maurorum extract modulates quorum sensing genes and biofilm formation in Proteus mirabilis. Sci Rep 2022; 12:13992. [PMID: 35978046 PMCID: PMC9385855 DOI: 10.1038/s41598-022-18362-x] [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: 06/07/2022] [Accepted: 08/10/2022] [Indexed: 11/12/2022] Open
Abstract
Proteus mirabilis (P. mirabilis) is a frequent cause of catheter-associated urinary tract infections. This study aims to investigate the anti-infective effect of Alhagi maurorum extract (AME), the traditional medicinal plant in the middle east, on the biofilm-forming P. mirabilis isolates. Hydroalcoholic extract and oil of A. maurorum were characterized by HPLC and GC–MS. The antiproliferative, anti-biofilm, and bactericidal activity of AME at various concentrations were assessed by turbidity, crystal violet binding, and agar well diffusion assays, respectively. The AME’s effect on adhesion and quorum sensing (QS) were investigated by in vitro adhesion assay on cell culture and agar overlay assay using Janthinobacterium lividum (ATCC 12472) as a biosensor strain. In addition, the expression level of selected genes involved in QS and biofilm regulation were determined by quantitative Real-Time PCR. Furthermore, the bladder phantom model was created to evaluate the assays and investigate the catheter’s calcium deposition. The most effective chemical compounds found in AME were tamarixetin, quercetin, and trans-anethole. Although AME did not inhibit swarming motility, it reduced biofilm production and exerted a concentration-dependent anti-adhesive and anti-QS activity against P. mirabilis. AME also downregulated the expression level of selected genes involved in biofilm formation and QS. This study showed that AME as a natural compound reduced biofilm formation of P. mirabilis by targeting virulence factor genes, quorum sensing, and other strategies that include preventing the adhesion of P. mirabilis to the cells. The results suggest that A. maurorum extract might have the potential to be considered for preventing UTIs caused by P. mirabilis.
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12
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Guerra MES, Destro G, Vieira B, Lima AS, Ferraz LFC, Hakansson AP, Darrieux M, Converso TR. Klebsiella pneumoniae Biofilms and Their Role in Disease Pathogenesis. Front Cell Infect Microbiol 2022; 12:877995. [PMID: 35646720 PMCID: PMC9132050 DOI: 10.3389/fcimb.2022.877995] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/13/2022] [Indexed: 12/17/2022] Open
Abstract
The ability to form biofilms is a crucial virulence trait for several microorganisms, including Klebsiella pneumoniae – a Gram-negative encapsulated bacterium often associated with nosocomial infections. It is estimated that 65-80% of bacterial infections are biofilm related. Biofilms are complex bacterial communities composed of one or more species encased in an extracellular matrix made of proteins, carbohydrates and genetic material derived from the bacteria themselves as well as from the host. Bacteria in the biofilm are shielded from immune responses and antibiotics. The present review discusses the characteristics of K. pneumoniae biofilms, factors affecting biofilm development, and their contribution to infections. We also explore different model systems designed to study biofilm formation in this species. A great number of factors contribute to biofilm establishment and maintenance in K. pneumoniae, which highlights the importance of this mechanism for the bacterial fitness. Some of these molecules could be used in future vaccines against this bacterium. However, there is still a lack of in vivo models to evaluate the contribution of biofilm development to disease pathogenesis. With that in mind, the combination of different methodologies has great potential to provide a more detailed scenario that more accurately reflects the steps and progression of natural infection.
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Affiliation(s)
- Maria Eduarda Souza Guerra
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Giulia Destro
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Brenda Vieira
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Alice S. Lima
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Lucio Fabio Caldas Ferraz
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Anders P. Hakansson
- Division of Experimental Infection Medicine, Department of Translational Medicine, Lund University, Malmo, Sweden
| | - Michelle Darrieux
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Thiago Rojas Converso
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
- *Correspondence: Thiago Rojas Converso,
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13
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Urinary Stent Development and Evaluation Models: In Vitro, Ex Vivo and In Vivo-A European Network of Multidisciplinary Research to Improve Urinary Stents (ENIUS) Initiative. Polymers (Basel) 2022; 14:polym14091641. [PMID: 35566810 PMCID: PMC9102855 DOI: 10.3390/polym14091641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/08/2022] [Accepted: 04/17/2022] [Indexed: 12/13/2022] Open
Abstract
Background: When trying to modify urinary stents, certain pre-clinical steps have to be followed before clinical evaluation in humans. Usually, the process starts as an in silico assessment. The urinary tract is a highly complex, dynamic and variable environment, which makes a computer simulation closely reflecting physiological conditions extremely challenging. Therefore, the pre-clinical evaluation needs to go through further steps of in vitro, ex vivo and in vivo assessments. Methods and materials: Within the European Network of Multidisciplinary Research to Improve Urinary Stents (ENIUS), the authors summarized and evaluated stent assessment models in silico, in vitro, ex vivo and in vivo. The topic and relevant sub-topics were researched in a systematic literature search in Embase, Scope, Web of Science and PubMed. Clinicaltrials.gov was consulted for ongoing trials. Articles were selected systematically according to guidelines with non-relevant, non-complete, and non-English or Spanish language articles excluded. Results: In the first part of this paper, we critically evaluate in vitro stent assessment models used over the last five decades, outlining briefly their strengths and weaknesses. In the second part, we provide a step-by-step guide on what to consider when setting up an ex vivo model for stent evaluation on the example of a biodegradable stent. Lastly, the third part lists and discusses the pros and cons of available animal models for urinary stent evaluation, this being the final step before human trials. Conclusions: We hope that this overview can provide a practical guide and a critical discussion of the experimental pre-clinical evaluation steps needed, which will help interested readers in choosing the right methodology from the start of a stent evaluation process once an in silico assessment has been completed. Only a transparent multidisciplinary approach using the correct methodology will lead to a successful clinical implementation of any new or modified stent.
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14
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Tae BS, Oh JJ, Jeong BC, Ku JH. Catheter-associated urinary tract infections in patients who have undergone radical cystectomy for bladder cancer: A prospective randomized clinical study of two silicone catheters (clinical benefit of antibiotic silicone material). Investig Clin Urol 2022; 63:334-340. [PMID: 35437959 PMCID: PMC9091833 DOI: 10.4111/icu.20210436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/20/2022] [Accepted: 02/03/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Materials and Methods Results Conclusions
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Affiliation(s)
- Bum Sik Tae
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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15
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Loose M, Sáez Moreno D, Mutti M, Hitzenhammer E, Visram Z, Dippel D, Schertler S, Tišáková LP, Wittmann J, Corsini L, Wagenlehner F. Natural Bred ε 2-Phages Have an Improved Host Range and Virulence against Uropathogenic Escherichia coli over Their Ancestor Phages. Antibiotics (Basel) 2021; 10:1337. [PMID: 34827275 PMCID: PMC8614997 DOI: 10.3390/antibiotics10111337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022] Open
Abstract
Alternative treatments for Escherichia coli infections are urgently needed, and phage therapy is a promising option where antibiotics fail, especially for urinary tract infections (UTI). We used wastewater-isolated phages to test their lytic activity against a panel of 47 E. coli strains reflecting the diversity of strains found in UTI, including sequence type 131, 73 and 69. The plaquing host range (PHR) was between 13 and 63%. In contrast, the kinetic host range (KHR), describing the percentage of strains for which growth in suspension was suppressed for 24 h, was between 0% and 19%, substantially lower than the PHR. To improve the phage host range and their efficacy, we bred the phages by mixing and propagating cocktails on a subset of E. coli strains. The bred phages, which we termed evolution-squared ε2-phages, of a mixture of Myoviridae have KHRs up to 23% broader compared to their ancestors. Furthermore, using constant phage concentrations, Myoviridae ε2-phages suppressed the growth of higher bacterial inocula than their ancestors did. Thus, the ε2-phages were more virulent compared to their ancestors. Analysis of the genetic sequences of the ε2-phages with the broadest host range reveals that they are mosaic intercrossings of 2-3 ancestor phages. The recombination sites are distributed over the whole length of the genome. All ε2-phages are devoid of genes conferring lysogeny, antibiotic resistance, or virulence. Overall, this study shows that ε2-phages are remarkably more suitable than the wild-type phages for phage therapy.
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Affiliation(s)
- Maria Loose
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, 35392 Giessen, Germany; (M.L.); (D.D.)
| | - David Sáez Moreno
- PhagoMed Biopharma GmbH, A-1110 Vienna, Austria; (D.S.M.); (M.M.); (E.H.); (Z.V.); (L.P.T.)
| | - Michele Mutti
- PhagoMed Biopharma GmbH, A-1110 Vienna, Austria; (D.S.M.); (M.M.); (E.H.); (Z.V.); (L.P.T.)
| | - Eva Hitzenhammer
- PhagoMed Biopharma GmbH, A-1110 Vienna, Austria; (D.S.M.); (M.M.); (E.H.); (Z.V.); (L.P.T.)
| | - Zehra Visram
- PhagoMed Biopharma GmbH, A-1110 Vienna, Austria; (D.S.M.); (M.M.); (E.H.); (Z.V.); (L.P.T.)
| | - David Dippel
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, 35392 Giessen, Germany; (M.L.); (D.D.)
| | - Susanne Schertler
- DSMZ—German Collection of Microorganism and Cell Cultures GmbH, Leibniz Institute, 38124 Braunschweig, Germany; (S.S.); (J.W.)
| | - Lenka Podpera Tišáková
- PhagoMed Biopharma GmbH, A-1110 Vienna, Austria; (D.S.M.); (M.M.); (E.H.); (Z.V.); (L.P.T.)
- DSMZ—German Collection of Microorganism and Cell Cultures GmbH, Leibniz Institute, 38124 Braunschweig, Germany; (S.S.); (J.W.)
| | - Johannes Wittmann
- DSMZ—German Collection of Microorganism and Cell Cultures GmbH, Leibniz Institute, 38124 Braunschweig, Germany; (S.S.); (J.W.)
| | - Lorenzo Corsini
- PhagoMed Biopharma GmbH, A-1110 Vienna, Austria; (D.S.M.); (M.M.); (E.H.); (Z.V.); (L.P.T.)
| | - Florian Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, 35392 Giessen, Germany; (M.L.); (D.D.)
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16
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Milo S, Heylen RA, Glancy J, Williams GT, Patenall BL, Hathaway HJ, Thet NT, Allinson SL, Laabei M, Jenkins ATA. A small-molecular inhibitor against Proteus mirabilis urease to treat catheter-associated urinary tract infections. Sci Rep 2021; 11:3726. [PMID: 33580163 PMCID: PMC7881204 DOI: 10.1038/s41598-021-83257-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/26/2021] [Indexed: 01/30/2023] Open
Abstract
Infection and blockage of indwelling urinary catheters is significant owing to its high incidence rate and severe medical consequences. Bacterial enzymes are employed as targets for small molecular intervention in human bacterial infections. Urease is a metalloenzyme known to play a crucial role in the pathogenesis and virulence of catheter-associated Proteus mirabilis infection. Targeting urease as a therapeutic candidate facilitates the disarming of bacterial virulence without affecting bacterial fitness, thereby limiting the selective pressure placed on the invading population and lowering the rate at which it will acquire resistance. We describe the design, synthesis, and in vitro evaluation of the small molecular enzyme inhibitor 2-mercaptoacetamide (2-MA), which can prevent encrustation and blockage of urinary catheters in a physiologically representative in vitro model of the catheterized urinary tract. 2-MA is a structural analogue of urea, showing promising competitive activity against urease. In silico docking experiments demonstrated 2-MA's competitive inhibition, whilst further quantum level modelling suggests two possible binding mechanisms.
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Affiliation(s)
- Scarlet Milo
- grid.7340.00000 0001 2162 1699Department of Chemistry, University of Bath, Bath, BA2 7AY UK
| | - Rachel A. Heylen
- grid.7340.00000 0001 2162 1699Department of Chemistry, University of Bath, Bath, BA2 7AY UK
| | - John Glancy
- grid.7340.00000 0001 2162 1699Department of Chemistry, University of Bath, Bath, BA2 7AY UK
| | - George T. Williams
- grid.9759.20000 0001 2232 2818School of Physical Sciences, University of Kent, Canterbury, CT2 7NH UK
| | - Bethany L. Patenall
- grid.7340.00000 0001 2162 1699Department of Chemistry, University of Bath, Bath, BA2 7AY UK
| | - Hollie J. Hathaway
- grid.9835.70000 0000 8190 6402Department of Chemistry, Lancaster University, Bailrigg, Lancaster, LA1 4YB UK
| | - Naing T. Thet
- grid.7340.00000 0001 2162 1699Department of Chemistry, University of Bath, Bath, BA2 7AY UK
| | - Sarah L. Allinson
- grid.9835.70000 0000 8190 6402Biomedical and Life Sciences Division, Lancaster University, Bailrigg, Lancaster, LA1 4YB UK
| | - Maisem Laabei
- grid.7340.00000 0001 2162 1699Department of Biology and Biochemistry, University of Bath, Bath, BA2 7AY UK
| | - A. Toby A. Jenkins
- grid.7340.00000 0001 2162 1699Department of Chemistry, University of Bath, Bath, BA2 7AY UK
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17
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Hennessen F, Miethke M, Zaburannyi N, Loose M, Lukežič T, Bernecker S, Hüttel S, Jansen R, Schmiedel J, Fritzenwanker M, Imirzalioglu C, Vogel J, Westermann AJ, Hesterkamp T, Stadler M, Wagenlehner F, Petković H, Herrmann J, Müller R. Amidochelocardin Overcomes Resistance Mechanisms Exerted on Tetracyclines and Natural Chelocardin. Antibiotics (Basel) 2020; 9:antibiotics9090619. [PMID: 32962088 PMCID: PMC7559539 DOI: 10.3390/antibiotics9090619] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022] Open
Abstract
The reassessment of known but neglected natural compounds is a vital strategy for providing novel lead structures urgently needed to overcome antimicrobial resistance. Scaffolds with resistance-breaking properties represent the most promising candidates for a successful translation into future therapeutics. Our study focuses on chelocardin, a member of the atypical tetracyclines, and its bioengineered derivative amidochelocardin, both showing broad-spectrum antibacterial activity within the ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) panel. Further lead development of chelocardins requires extensive biological and chemical profiling to achieve favorable pharmaceutical properties and efficacy. This study shows that both molecules possess resistance-breaking properties enabling the escape from most common tetracycline resistance mechanisms. Further, we show that these compounds are potent candidates for treatment of urinary tract infections due to their in vitro activity against a large panel of multidrug-resistant uropathogenic clinical isolates. In addition, the mechanism of resistance to natural chelocardin was identified as relying on efflux processes, both in the chelocardin producer Amycolatopsis sulphurea and in the pathogen Klebsiella pneumoniae. Resistance development in Klebsiella led primarily to mutations in ramR, causing increased expression of the acrAB-tolC efflux pump. Most importantly, amidochelocardin overcomes this resistance mechanism, revealing not only the improved activity profile but also superior resistance-breaking properties of this novel antibacterial compound.
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Affiliation(s)
- Fabienne Hennessen
- Department of Microbial Natural Products, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS)—Helmholtz Centre for Infection Research (HZI), and Department of Pharmacy, Saarland University Campus E8.1, 66123 Saarbrücken, Germany; (F.H.); (M.M.); (N.Z.); (T.L.)
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany; (S.B.); (S.H.); (R.J.); (T.H.); (M.S.)
| | - Marcus Miethke
- Department of Microbial Natural Products, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS)—Helmholtz Centre for Infection Research (HZI), and Department of Pharmacy, Saarland University Campus E8.1, 66123 Saarbrücken, Germany; (F.H.); (M.M.); (N.Z.); (T.L.)
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany; (S.B.); (S.H.); (R.J.); (T.H.); (M.S.)
| | - Nestor Zaburannyi
- Department of Microbial Natural Products, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS)—Helmholtz Centre for Infection Research (HZI), and Department of Pharmacy, Saarland University Campus E8.1, 66123 Saarbrücken, Germany; (F.H.); (M.M.); (N.Z.); (T.L.)
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany; (S.B.); (S.H.); (R.J.); (T.H.); (M.S.)
| | - Maria Loose
- Clinic for Urology, Paediatric Urology & Andrology, Justus-Liebig University Gießen, and German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, 35392 Gießen, Germany; (M.L.); (F.W.)
| | - Tadeja Lukežič
- Department of Microbial Natural Products, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS)—Helmholtz Centre for Infection Research (HZI), and Department of Pharmacy, Saarland University Campus E8.1, 66123 Saarbrücken, Germany; (F.H.); (M.M.); (N.Z.); (T.L.)
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany; (S.B.); (S.H.); (R.J.); (T.H.); (M.S.)
- National Institute of Biology, Večna pot 111, 1000 Ljubljana, Slovenia
| | - Steffen Bernecker
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany; (S.B.); (S.H.); (R.J.); (T.H.); (M.S.)
- Department of Microbial Drugs, Helmholtz Centre for Infection Research (HZI), Inhoffenstrasse 7, 38124 Braunschweig, Germany
| | - Stephan Hüttel
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany; (S.B.); (S.H.); (R.J.); (T.H.); (M.S.)
- Department of Microbial Drugs, Helmholtz Centre for Infection Research (HZI), Inhoffenstrasse 7, 38124 Braunschweig, Germany
| | - Rolf Jansen
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany; (S.B.); (S.H.); (R.J.); (T.H.); (M.S.)
- Department of Microbial Drugs, Helmholtz Centre for Infection Research (HZI), Inhoffenstrasse 7, 38124 Braunschweig, Germany
| | - Judith Schmiedel
- Institute of Medical Microbiology, Justus-Liebig University Gießen, and German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, 35390 Gießen, Germany; (J.S.); (M.F.); (C.I.)
| | - Moritz Fritzenwanker
- Institute of Medical Microbiology, Justus-Liebig University Gießen, and German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, 35390 Gießen, Germany; (J.S.); (M.F.); (C.I.)
| | - Can Imirzalioglu
- Institute of Medical Microbiology, Justus-Liebig University Gießen, and German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, 35390 Gießen, Germany; (J.S.); (M.F.); (C.I.)
| | - Jörg Vogel
- Helmholtz Institute for RNA-based Infection Research (HIRI), Helmholtz Centre for Infection Research (HZI) and Institute of Molecular Infection Biology (IMIB), University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany; (J.V.); (A.J.W.)
| | - Alexander J. Westermann
- Helmholtz Institute for RNA-based Infection Research (HIRI), Helmholtz Centre for Infection Research (HZI) and Institute of Molecular Infection Biology (IMIB), University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany; (J.V.); (A.J.W.)
| | - Thomas Hesterkamp
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany; (S.B.); (S.H.); (R.J.); (T.H.); (M.S.)
| | - Marc Stadler
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany; (S.B.); (S.H.); (R.J.); (T.H.); (M.S.)
- Department of Microbial Drugs, Helmholtz Centre for Infection Research (HZI), Inhoffenstrasse 7, 38124 Braunschweig, Germany
| | - Florian Wagenlehner
- Clinic for Urology, Paediatric Urology & Andrology, Justus-Liebig University Gießen, and German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, 35392 Gießen, Germany; (M.L.); (F.W.)
| | - Hrvoje Petković
- Department of Food Science and Technology, Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, 1000 Ljubljana, Slovenia;
| | - Jennifer Herrmann
- Department of Microbial Natural Products, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS)—Helmholtz Centre for Infection Research (HZI), and Department of Pharmacy, Saarland University Campus E8.1, 66123 Saarbrücken, Germany; (F.H.); (M.M.); (N.Z.); (T.L.)
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany; (S.B.); (S.H.); (R.J.); (T.H.); (M.S.)
- Correspondence: (J.H.); (R.M.); Tel.: +49-681-98806-3101 (J.H.); +49-681-98806-3000 (R.M.)
| | - Rolf Müller
- Department of Microbial Natural Products, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS)—Helmholtz Centre for Infection Research (HZI), and Department of Pharmacy, Saarland University Campus E8.1, 66123 Saarbrücken, Germany; (F.H.); (M.M.); (N.Z.); (T.L.)
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany; (S.B.); (S.H.); (R.J.); (T.H.); (M.S.)
- Correspondence: (J.H.); (R.M.); Tel.: +49-681-98806-3101 (J.H.); +49-681-98806-3000 (R.M.)
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18
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Anti-Bacterial Effects of Essential Oils against Uropathogenic Bacteria. Antibiotics (Basel) 2020; 9:antibiotics9060358. [PMID: 32630444 PMCID: PMC7344393 DOI: 10.3390/antibiotics9060358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022] Open
Abstract
Given the increasing antimicrobial resistance in urinary tract infections (UTI), alternative strategies need to be investigated. Determination of minimal inhibitory and bactericidal concentrations of essential oils from cajeput, lemongrass, tea tree, and thyme in artificial urine, revealed bactericidal activity of all four tested essential oils against seven uropathogenic species with values ranging between 0.78–50 mg/mL. Tea tree and thyme essential oils were more efficient than lemongrass and cajeput. In addition, antibiotic-resistant strains showed similar susceptibility as antibiotic-sensitive strains, suggesting no cross-resistance between antibiotics and these essential oils. Checkerboard assays revealed a synergistic activity of the combination of thyme and tea tree. Furthermore, the combination with thyme and tea tree essential oils increased the activity of fosfomycin and pivmecillinam, but not nitrofurantoin, against Escherichia coli. This study provides a basis for further investigation of the potential of thyme and tea tree oil as an alternative or additional treatment of UTI.
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19
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Durgadevi R, Kaleeshwari R, Swetha TK, Alexpandi R, Karutha Pandian S, Veera Ravi A. Attenuation of Proteus mirabilis colonization and swarming motility on indwelling urinary catheter by antibiofilm impregnation: An in vitro study. Colloids Surf B Biointerfaces 2020; 194:111207. [PMID: 32590245 DOI: 10.1016/j.colsurfb.2020.111207] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 02/05/2023]
Abstract
Proteus mirabilis is one of the important etiologic agents of urinary tract infections (UTI), which complicates the long-term urinary catheterization process in clinical settings. Owing to its crystalline biofilm forming ability and flagellar motility, elimination of P. mirabilis from urinary system becomes very difficult. Thus, the present study is focused to prepare antibiofilm-impregnated Silicone Foley Catheter (SFC) to prevent P. mirabilis instigated UTIs. Through solvent swelling method, the antibiofilm compounds such as linalool (LIN) and 2-hydroxy-4-methoxy benzaldehyde (HMB) were successfully infused into SFCs. Surface topography was studied using AFM analysis, which unveiled the unmodified surface roughness of normal and antibiofilm-impregnated SFCs. In addition, UV-spectrometric and FT-IR analyses revealed good impregnation efficacy and prolonged stability of antibiofilm compounds. Further, in vitro biofilm biomass quantification assay exhibited a maximum of 87 % and 84 % crystalline biofilm inhibition in LIN (350 μg/cm3) and HMB (120 μg/cm3) impregnated SFCs, respectively against P. mirabilis in artificial urine medium. Also, the LIN & HMB-impregnated SFCs demonstrated long-term crystalline biofilm inhibitory activity for more than 30 days, which is ascribed to the sustained release of the compounds. Furthermore, the results of swarming motility analysis revealed the efficacy of antibiofilm-impregnated catheters to mitigate the migration of pathogens over them. Thus, antibiofilm-impregnated catheter is proposed to act as a suitable strategy for reducing P. mirabilis infections and associated complications in long-term urinary catheter users.
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20
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Pearson MM. Culture Methods for Proteus mirabilis. METHODS IN MOLECULAR BIOLOGY (CLIFTON, N.J.) 2020; 2021:5-13. [PMID: 31309491 DOI: 10.1007/978-1-4939-9601-8_2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Proteus mirabilis is generally easy to culture, but its tendency to swarm on a wide variety of media can interfere with isolation of single colonies or identification of other species in a sample. Therefore, specialized media may be needed to control swarming or to study the bacteria under chemically defined conditions. Here, methods are described for routine culture of P. mirabilis, isolation of P. mirabilis from mixed cultures, and culture of P. mirabilis on physiologically relevant media.
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Affiliation(s)
- Melanie M Pearson
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA.
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21
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Loose M, Naber KG, Coates A, Wagenlehner FME, Hu Y. Effect of Different Media on the Bactericidal Activity of Colistin and on the Synergistic Combination With Azidothymidine Against mcr-1-Positive Colistin-Resistant Escherichia coli. Front Microbiol 2020; 11:54. [PMID: 32063896 PMCID: PMC7000358 DOI: 10.3389/fmicb.2020.00054] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 01/13/2020] [Indexed: 01/01/2023] Open
Abstract
Antimicrobial susceptibility testing (AST) performed according to defined guidelines is important to identify resistance and to predict the clinical success or failure of specific antibiotic therapy. However, these guidelines do not cover all physiological conditions that can have a tremendous impact on in vivo resistance. In this study, we tested the susceptibility of thirteen mcr-1-positive Escherichia coli strains against colistin, one of the last resort antibiotics for treating multi-drug resistant pathogens, in media recommended for ASTs as well as – physiologically more relevant – in human serum and artificial urine (AU). Minimal inhibitory concentration (MIC) values in heat-inactivated human serum were similar to those in cation-adjusted Mueller-Hinton broth (CAMHB), but reduced in native serum for almost all strains that could grow in this media. In AU MIC values for mcr-1 positive E. coli were increased significantly up to 16-fold compared to that in CAMBH, which did not apply to the colistin-susceptible E. coli strains tested. Although different growth media could affect the MIC of colistin alone, their impact on the synergistic effect of the combination with the antiviral drug azidothymidine was minimal. The higher divalent cation concentration combined with acidic pH values is most likely responsible for the increased MIC values of the mcr-1 harboring E. coli strains tested against colistin in AU compared to that in CAMHB. Antimicrobial susceptibility screening procedures for colistin using CAMHB only could lead to an underestimation of resistance under different physiological conditions. Therefore, not only pharmacokinetic but also pharmacodynamic studies in urine are as important as in serum or plasma.
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Affiliation(s)
- Maria Loose
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, Giessen, Germany
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Anthony Coates
- Institute for Infection and Immunity, St George's, University of London, London, United Kingdom.,Helperby Therapeutics Ltd., London, United Kingdom
| | - Florian M E Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, Giessen, Germany
| | - Yanmin Hu
- Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
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22
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Loose M, Link I, Naber KG, Wagenlehner FME. Carbapenem-Containing Combination Antibiotic Therapy against Carbapenem-Resistant Uropathogenic Enterobacteriaceae. Antimicrob Agents Chemother 2019; 64:e01839-19. [PMID: 31636073 PMCID: PMC7187590 DOI: 10.1128/aac.01839-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/15/2019] [Indexed: 01/01/2023] Open
Abstract
The increasing global prevalence of carbapenem-resistant Enterobacteriaceae (CRE) combined with the decline in effective therapies is a public health care crisis. After respiratory tract infections, urinary tract infections and associated urosepsis are the second most affected by CRE pathogens. By using checkerboard analysis, we tested eight different antibiotics in combination with carbapenems in CAMHB (cation-adjusted Müller-Hinton broth) and artificial urine against seven CRE strains and three susceptible strains. To further determine whether these combinations are also effective in a dynamic model, we have performed growth curves analyses in a dynamic bladder model with three uropathogenic CRE strains. In this model, we simulated the urinary pharmacokinetic after application of 1,000 mg intravenous (i.v.) ertapenem alone or in combination with 500 mg i.v. levofloxacin, 1,000 mg oral rifampin, or 3,000 mg oral fosfomycin. Bacterial growth was measured for 48 h, simulating voiding of the bladder every 3 h. According to the median fractional inhibitory concentration indices (ΣFICIs), the values we found were additive to synergistic results across all tested CRE strains for combinations of carbapenems with colistin sulfate, levofloxacin, fosfomycin, rifampin, and tigecycline in CAMHB and artificial urine. In the dynamic bladder model, all three CRE strains tested showed regrowth after treatment with ertapenem up to 48 h. Regrowth could be prevented by combination with levofloxacin, fosfomycin, or rifampin. Carbapenem-containing combination therapy with fosfomycin or rifampin could be an option for better treatment of urinary tract infections (UTIs) caused by CRE strains. This should be further investigated in clinical studies.
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Affiliation(s)
- Maria Loose
- Clinic for Urology, Paediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Isabell Link
- Clinic for Urology, Paediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | | | - Florian M E Wagenlehner
- Clinic for Urology, Paediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
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23
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Cortese YJ, Wagner VE, Tierney M, Scully D, Devine DM, Fogarty A. Pathogen displacement during intermittent catheter insertion: a novel in vitro urethra model. J Appl Microbiol 2019; 128:1191-1200. [PMID: 31782866 DOI: 10.1111/jam.14533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/05/2019] [Accepted: 11/25/2019] [Indexed: 11/28/2022]
Abstract
AIM To develop a novel in vitro urethra model and use it to determine if insertion of an intermittent urinary catheter (IC) displaces pathogenic bacteria from the urethral meatus along the urethra. METHODS Displacement of microbial growth after catheter insertion was assessed using a novel in vitro urethra model. The in vitro urethra model utilized chromogenic agar and was inoculated with bacteria at one side of the artificial urethra channel, to act as a contaminated urethral meatus, before an IC was inserted into the channel. Three ICs types were used to validate the in vitro urethra model and methodology. RESULTS When compared to the bacterial growth control, a significant difference in bacterial growth was found after insertion of the uncoated (P ≤ 0·001) and hydrophilic coated (P ≤ 0·009) catheters; no significant difference when a prototype catheter was inserted into the in vitro urethra model with either bacterial species tested (P ≥ 0·423). CONCLUSION The results presented support the hypothesis that a single catheter insertion can initiate a catheter-associated urinary tract infection. SIGNIFICANCE AND IMPACT OF THE STUDY The in vitro urethra model and associated methodology were found to be reliable and reproducible (P ≥ 0·265) providing new research tool for the development and validation of emerging technologies in urological healthcare.
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Affiliation(s)
- Y J Cortese
- Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland.,Bioscience Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | - V E Wagner
- Global Advanced Engineering, Teleflex, Reading, PA, USA
| | - M Tierney
- Global Advanced Engineering, Teleflex Medical Europe Ltd, Athlone, Ireland
| | - D Scully
- Global Advanced Engineering, Teleflex Medical Europe Ltd, Athlone, Ireland
| | - D M Devine
- Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | - A Fogarty
- Bioscience Research Institute, Athlone Institute of Technology, Athlone, Ireland.,Department of Life and Physical Science, Athlone Institute of Technology, Athlone, Ireland
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24
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Pelling H, Bock LJ, Nzakizwanayo J, Wand ME, Denham EL, MacFarlane WM, Sutton JM, Jones BV. De-repression of the smvA efflux system arises in clinical isolates of Proteus mirabilis and reduces susceptibility to chlorhexidine and other biocides. Antimicrob Agents Chemother 2019; 63:AAC.01535-19. [PMID: 31570392 PMCID: PMC6879213 DOI: 10.1128/aac.01535-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/18/2019] [Indexed: 01/14/2023] Open
Abstract
Proteus mirabilis is a common pathogen of the catheterised urinary tract and often described as intrinsically resistant to the biocide chlorhexidine (CHD). Here we demonstrate that de-repression of the smvA efflux system has occurred in clinical isolates of P. mirabilis and reduces susceptibility to CHD and other cationic biocides. Compared to other isolates examined, P. mirabilis RS47 exhibited a significantly higher CHD MIC (≥512 μg/ml) and significantly greater expression of smvA. Comparison of the RS47 smvA and cognate smvR repressor with sequences from other isolates, indicated that RS47 encodes an inactivated smvR. Complementation of RS47 with a functional smvR from isolate RS50a (which exhibited the lowest smvA expression and lowest CHD MIC) reduced smvA expression by ∼59-fold, and markedly lowered the MIC of CHD and other cationic biocides. Although complementation of RS47 did not reduce MICs to concentrations observed in isolate RS50a, the significantly lower polymyxin B MIC of RS50a indicated that differences in LPS structure are also a factor in P. mirabilis CHD susceptibility. To determine if exposure to CHD can select for mutations in smvR, clinical isolates with the lowest CHD MICs were adapted to grow at increasing concentrations of CHD up to 512 μg/ml. Analysis of the smvR in adapted populations indicated that mutations predicted to inactivate smvR occurred following CHD exposure in some isolates. Collectively, our data show that smvA de-repression contributes to reduced biocide susceptibility in P. mirabilis, but differences in LPS structure between strains are also likely to be an important factor.
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Affiliation(s)
- H Pelling
- Dept. of Biology and Biochemistry, University of Bath, Claverton Down, Bath, BA2 7AY, UK
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, BN2 4GJ, UK
| | - L J Bock
- National Infections Service, Public Health England, Porton Down, Salisbury, SP4 0JG, UK
| | - J Nzakizwanayo
- Dept. of Biology and Biochemistry, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - M E Wand
- National Infections Service, Public Health England, Porton Down, Salisbury, SP4 0JG, UK
| | - E L Denham
- Dept. of Biology and Biochemistry, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - W M MacFarlane
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, BN2 4GJ, UK
| | - J M Sutton
- National Infections Service, Public Health England, Porton Down, Salisbury, SP4 0JG, UK
| | - B V Jones
- Dept. of Biology and Biochemistry, University of Bath, Claverton Down, Bath, BA2 7AY, UK
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25
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Wang L, Zhang S, Keatch R, Corner G, Nabi G, Murdoch S, Davidson F, Zhao Q. In-vitro antibacterial and anti-encrustation performance of silver-polytetrafluoroethylene nanocomposite coated urinary catheters. J Hosp Infect 2019; 103:55-63. [DOI: 10.1016/j.jhin.2019.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
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26
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An In Vitro Bladder Model for Studying Catheter-Associated Urinary Tract Infection and Associated Analysis of Biofilms. METHODS IN MOLECULAR BIOLOGY (CLIFTON, N.J.) 2019; 2021:139-158. [PMID: 31309503 DOI: 10.1007/978-1-4939-9601-8_14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Urethral catheters are among the most widely used medical devices, applied to manage a wide range of conditions in hospital, community, and care home settings. In long-term catheterized individuals, infection with Proteus mirabilis frequently complicates the care of patients owing to formation of extensive crystalline biofilms. Here we describe the use of an in vitro bladder model of the catheterized urinary tract and associated analyses to study P. mirabilis crystalline biofilm formation. The model originally described by Stickler et al. (1999, 310:494-501, Methods Enzymol) replicates a complete sterile closed drainage system as used in clinical practice, and permits formation of biofilms directly on catheters under conditions representative of those encountered in vivo. Models may be used to replicate either established infection or early stage colonization, and we describe a range of associated methods for quantification and visualization of biofilms formed on catheters. These methods are also easily adapted to study catheter-associated biofilm formation by other urinary tract pathogens.
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27
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Urinary bactericidal activity of colistin and azidothymidine combinations against mcr-1-positive colistin-resistant Escherichia coli. Int J Antimicrob Agents 2019; 54:55-61. [DOI: 10.1016/j.ijantimicag.2019.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/29/2019] [Accepted: 04/20/2019] [Indexed: 11/19/2022]
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28
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Imani Rad H, Peeri H, Amani M, Mohammadnia A, Ogunniyi AD, Khazandi M, Venter H, Arzanlou M. Allicin prevents the formation of Proteus-induced urinary crystals and the blockage of catheter in a bladder model in vitro. Microb Pathog 2019; 132:293-301. [PMID: 31082531 DOI: 10.1016/j.micpath.2019.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
Stone formation and catheter blockage are major complications of Proteus UTIs. In this study, we investigated the ability of allicin to inhibit P. mirabilis-induced struvite crystallization and catheter blockage using a synthetic bladder model. Struvite crystallization inhibition study was carried out using P. mirabilis lysate as urease enzyme source in synthetic urine (SU). Struvite productions were monitored by phase contrast light microscopy and measurements of pH, Mg2+ and Ca2+ precipitation and turbidity. A catheter blockage study was performed in a synthetic bladder model mimicking natural UTI in the presence of allicin at sub-MIC concentrations (MIC = 64 μg/ml). The results of crystallization study showed that allicin inhibited pH rise and consequently turbidity and precipitation of ions in a dose-dependent manner. The results of catheter blockage study showed that allicin at sub-MIC concentrations (2, 4, 8 μg/ml) significantly increased the time for catheter blockage to occur to 61, 74 and 92 h respectively compared to allicin-free control (48 h). In a similar way, the results showed that allicin delayed the increase of SU pH level in bladder model in a dose-dependent manner compared to allicin-free control. The results also showed that following the increase of allicin concentration, Mg2+ and Ca2+ deposition in catheters were much lower compared to allicin-free control, further confirmed by direct observation of the catheters' eyehole and cross sections. We conclude that allicin prevents the formation of Proteus-induced urinary crystals and the blockage of catheters by delaying pH increase and lowering Mg2+ and Ca2+ deposition in a dose-dependent manner.
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Affiliation(s)
- Hamed Imani Rad
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hadi Peeri
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mojtaba Amani
- Department of Clinical Chemistry, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran; Department of Biochemistry, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Alireza Mohammadnia
- Department of Information Technologies, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Abiodun David Ogunniyi
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, Australia
| | - Manouchehr Khazandi
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, Australia
| | - Henrietta Venter
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, 5000, Australia
| | - Mohsen Arzanlou
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
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29
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Durgadevi R, Veera Ravi A, Alexpandi R, Krishnan Swetha T, Abirami G, Vishnu S, Karutha Pandian S. Virulence targeted inhibitory effect of linalool against the exclusive uropathogen Proteus mirabilis. BIOFOULING 2019; 35:508-525. [PMID: 31144520 DOI: 10.1080/08927014.2019.1619704] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 06/09/2023]
Abstract
Proteus mirabilis is one of the leading causes of catheter-associated UTIs (CAUTI) in individuals with prolonged urinary catheterization. Since, biofilm assisted antibiotic resistance is reported to complicate the treatment strategies of P. mirabilis infections, the present study was aimed to attenuate biofilm and virulence factor production in P. mirabilis. Linalool is a naturally occurring monoterpene alcohol found in a wide range of flowers and spice plants and has many biological applications. In this study, linalool exhibited concentration dependent anti-biofilm activity against crystalline biofilm of P. mirabilis through reduced production of the virulence enzyme urease that raises the urinary pH and drives the formation of crystals (struvite) in the biofilm. The results of q-PCR analysis unveiled the down regulation of biofilm/virulence associated genes upon linalool treatment, which was in correspondence with the in vitro bioassays. Thus, this study reports the feasibility of linalool acting as a promising anti-biofilm agent against P. mirabilis mediated CAUTI.
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Affiliation(s)
| | | | - Rajaiah Alexpandi
- Department of Biotechnology, Alagappa University , Tamil Nadu , India
| | | | - Gurusamy Abirami
- Department of Biotechnology, Alagappa University , Tamil Nadu , India
| | - Selvam Vishnu
- Department of Biotechnology, Alagappa University , Tamil Nadu , India
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30
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Abbott IJ, Meletiadis J, Belghanch I, Wijma RA, Kanioura L, Roberts JA, Peleg AY, Mouton JW. Fosfomycin efficacy and emergence of resistance among Enterobacteriaceae in an in vitro dynamic bladder infection model. J Antimicrob Chemother 2019; 73:709-719. [PMID: 29253153 DOI: 10.1093/jac/dkx441] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/31/2017] [Indexed: 01/06/2023] Open
Abstract
Background Urinary tract infections (UTIs) are among the most common bacterial infections and a frequent indication for antibiotic use. Fosfomycin, an important oral antibiotic for outpatient UTIs, remains a viable option for MDR uropathogens. We aimed to perform pharmacodynamic profiling simulating urinary concentrations to assess the adequacy of the current dosing regimen. Methods A dynamic in vitro bladder infection model was developed, replicating urinary fosfomycin concentrations after gastrointestinal absorption, systemic distribution and urinary elimination. Concentrations were measured by LC-MS/MS. Twenty-four Enterobacteriaceae strains (Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae; MIC range 0.25-64 mg/L) were examined. Pathogen kill and emergence of resistance was assessed over 72 h. Results Observed in vitro fosfomycin concentrations accurately simulated urinary fosfomycin exposures (Tmax 3.8 ± 0.5 h; Cmax 2630.1 ± 245.7 mg/L; AUC0-24 33 932.5 ± 1964.2 mg·h/L). Fifteen of 24 isolates regrew, with significant rises in fosfomycin MIC (total population MIC50 4 to 64 mg/L, MIC90 64 to > 1024 mg/L, P = 0.0039; resistant subpopulation MIC50 128 to > 1024 mg/L, MIC90 >1024 mg/L, P = 0.0020). E. coli and E. cloacae isolates were killed with pharmacokinetic/pharmacodynamic EI50 of fAUC0-24/MIC = 1922, fCmax/MIC = 149 and fTime>4×MIC = 44 h. In contrast, K. pneumoniae isolates were not reliably killed. Conclusions Using dynamic in vitro simulations of urinary fosfomycin exposures, E. coli and E. cloacae isolates with MIC >16 mg/L, and all K. pneumoniae isolates, were not reliably killed. Emergence of resistance was significant. This challenges fosfomycin dosing and clinical breakpoints, and questions the utility of fosfomycin against K. pneumoniae. Further work on in vitro dose optimization is required.
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Affiliation(s)
- Iain J Abbott
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medical Microbiology and Infectious Diseases, Research and Development Unit, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Joseph Meletiadis
- Department of Medical Microbiology and Infectious Diseases, Research and Development Unit, Erasmus Medical Centre, Rotterdam, The Netherlands.,Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Haidari, Athens, Greece
| | - Imane Belghanch
- Department of Medical Microbiology and Infectious Diseases, Research and Development Unit, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Rixt A Wijma
- Department of Medical Microbiology and Infectious Diseases, Research and Development Unit, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Lamprini Kanioura
- Department of Medical Microbiology and Infectious Diseases, Research and Development Unit, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jason A Roberts
- Faculty of Medicine and School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.,Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Anton Y Peleg
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Victoria, Australia
| | - Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Research and Development Unit, Erasmus Medical Centre, Rotterdam, The Netherlands
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31
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Cortese YJ, Wagner VE, Tierney M, Devine D, Fogarty A. Review of Catheter-Associated Urinary Tract Infections and In Vitro Urinary Tract Models. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:2986742. [PMID: 30405898 PMCID: PMC6204192 DOI: 10.1155/2018/2986742] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/01/2018] [Accepted: 07/03/2018] [Indexed: 12/22/2022]
Abstract
Catheter-associated urinary tract infections (CAUTIs) are one of the most common nosocomial infections and can lead to numerous medical complications from the mild catheter encrustation and bladder stones to the severe septicaemia, endotoxic shock, and pyelonephritis. Catheters are one of the most commonly used medical devices in the world and can be characterised as either indwelling (ID) or intermittent catheters (IC). The primary challenges in the use of IDs are biofilm formation and encrustation. ICs are increasingly seen as a solution to the complications caused by IDs as ICs pose no risk of biofilm formation due to their short time in the body and a lower risk of bladder stone formation. Research on IDs has focused on the use of antimicrobial and antibiofilm compounds, while research on ICs has focused on preventing bacteria entering the urinary tract or coming into contact with the catheter. There is an urgent need for in vitro urinary tract models to facilitate faster research and development for CAUTI prevention. There are currently three urinary tract models that test IDs; however, there is only a single very limited model for testing ICs. There is currently no standardised urinary tract model to test the efficacies of ICs.
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Affiliation(s)
- Yvonne J. Cortese
- Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland
- Bioscience Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | | | | | - Declan Devine
- Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | - Andrew Fogarty
- Bioscience Research Institute, Athlone Institute of Technology, Athlone, Ireland
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Maskarinec SA, Parlak Z, Tu Q, Levering V, Zauscher S, López GP, Fowler VG, Perfect JR. On-demand release of Candida albicans biofilms from urinary catheters by mechanical surface deformation. BIOFOULING 2018; 34:595-604. [PMID: 29897277 PMCID: PMC6276112 DOI: 10.1080/08927014.2018.1474461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/02/2018] [Indexed: 06/08/2023]
Abstract
Candida albicans is a leading cause of catheter-associated urinary tract infections and elimination of these biofilm-based infections without antifungal agents would constitute a significant medical advance. A novel urinary catheter prototype that utilizes on-demand surface deformation is effective at eliminating bacterial biofilms and here the broader applicability of this prototype to remove fungal biofilms has been demonstrated. C. albicans biofilms were debonded from prototypes by selectively inflating four additional intralumens surrounding the main lumen of the catheters to provide the necessary surface strain to remove the adhered biofilm. Deformable catheters eliminated significantly more biofilm than the controls (>90% eliminated vs 10% control; p < 0.001). Mechanical testing revealed that fungal biofilms have an elastic modulus of 45 ± 6.7 kPa with a fracture energy of 0.4-2 J m-2. This study underscores the potential of mechanical disruption as a materials design strategy to combat fungal device-associated infections.
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Affiliation(s)
- Stacey A. Maskarinec
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Zehra Parlak
- Mechanical Engineering & Materials Science, Duke University, Durham, NC, USA
| | - Qing Tu
- Mechanical Engineering & Materials Science, Duke University, Durham, NC, USA
| | - Vrad Levering
- Biomedical Engineering, Duke University, Durham, NC, USA
| | - Stefan Zauscher
- Mechanical Engineering & Materials Science, Duke University, Durham, NC, USA
| | - Gabriel P. López
- Chemical and Biological Engineering, University of New Mexico, Albuquerque, NM, USA
| | - Vance G. Fowler
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - John R. Perfect
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
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Milo S, Acosta FB, Hathaway HJ, Wallace LA, Thet NT, Jenkins ATA. Development of an Infection-Responsive Fluorescent Sensor for the Early Detection of Urinary Catheter Blockage. ACS Sens 2018; 3:612-617. [PMID: 29443508 DOI: 10.1021/acssensors.7b00861] [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: 11/29/2022]
Abstract
Formation of crystalline biofilms following infection by Proteus mirabilis can lead to encrustation and blockage of long-term indwelling catheters, with serious clinical consequences. We describe a simple sensor, placed within the catheter drainage bag, to alert of impending blockage via a urinary color change. The pH-responsive sensor is a dual-layered polymeric "lozenge", able to release the self-quenching dye 5(6)-carboxyfluorescein in response to the alkaline urine generated by the expression of bacterial urease. Sensor performance was evaluated within a laboratory model of the catheterized urinary tract, infected with both urease positive and negative bacterial strains under conditions of established infection, achieving an average "early warning" of catheter blockage of 14.5 h. Signaling only occurred following infection with urease positive bacteria. Translation of these sensors into a clinical environment would allow appropriate intervention before the occurrence of catheter blockage, a problem for which there is currently no effective control method.
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Affiliation(s)
- Scarlet Milo
- Department of Chemistry, University of Bath, Bath BA2 7AY, United Kingdom
| | | | - Hollie J. Hathaway
- Department of Chemistry, University of Bath, Bath BA2 7AY, United Kingdom
| | - Laura A. Wallace
- Department of Chemistry, University of Bath, Bath BA2 7AY, United Kingdom
| | - Naing T. Thet
- Department of Chemistry, University of Bath, Bath BA2 7AY, United Kingdom
| | - A. Toby A. Jenkins
- Department of Chemistry, University of Bath, Bath BA2 7AY, United Kingdom
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Guildford A, Morris C, Kitt O, Cooper I. The effect of urinary Foley catheter substrate material on the antimicrobial potential of calixerene‐based molecules. J Appl Microbiol 2018; 124:1047-1059. [DOI: 10.1111/jam.13658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 09/05/2017] [Accepted: 11/20/2017] [Indexed: 11/27/2022]
Affiliation(s)
- A. Guildford
- School of Pharmacy & Biomolecular Sciences University of Brighton Brighton UK
| | - C. Morris
- School of Pharmacy & Biomolecular Sciences University of Brighton Brighton UK
| | - O. Kitt
- School of Pharmacy & Biomolecular Sciences University of Brighton Brighton UK
| | - I. Cooper
- School of Pharmacy & Biomolecular Sciences University of Brighton Brighton UK
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35
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Affiliation(s)
- Bente Olesen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
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36
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Cooper IR, Pollini M, Paladini F. The potential of photo-deposited silver coatings on Foley catheters to prevent urinary tract infections. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 69:414-20. [DOI: 10.1016/j.msec.2016.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/24/2016] [Accepted: 07/04/2016] [Indexed: 11/30/2022]
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Laube N, Desai C, Bernsmann F. Hydrophobic forces as a key factor in crystalline biofilm formation on ureteral stents. BIOMED ENG-BIOMED TE 2016; 61:483-490. [PMID: 26943591 DOI: 10.1515/bmt-2015-0160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 02/02/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Current discussions about biofilm formation focus on the solid/liquid interface between a medical device and body fluids. Yet it has been shown that gas bubbles (GB) can stably form on ureteral stents in artificial urine and that their fate depends on the stent's surface properties. The liquid/gas interface constitutes an adhesion site for precipitating salts as well as hydrophobic organic molecules. MATERIALS AND METHODS The surface wettability of polyurethane stents is varied by coating with amorphous hydrogenated carbon (a-C:H). GB and crystalline biofilm formation on the stents are investigated in a novel encrustation device which avoids gravitation- or sample-position-related influences on the results. RESULTS Bigger and more stable GB form on hydrophobic stents than on hydrophilic, coated stents. Appearance and amount of crystalline deposits differ significantly between the surfaces. With decreasing wettability the number of hollow crystalline spheres and the mass of precipitate increase. CONCLUSIONS On hydrophobic surfaces, stable GB increase precipitation of salts and become incorporated in the growing encrustation layer in vitro. In contrast, GB quickly lift off from hydrophilic surfaces taking part of the precipitate with them. This self-cleaning mechanism slows down the encrustation process. A similar effect may explain the prolonged complication-free indwelling time of amorphous-carbon coated stents in vivo.
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38
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Water consumption and urinary tract infections: an in vitro study. Int Urol Nephrol 2016; 48:949-54. [DOI: 10.1007/s11255-016-1262-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
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Francesko A, Fernandes MM, Ivanova K, Amorim S, Reis RL, Pashkuleva I, Mendoza E, Pfeifer A, Heinze T, Tzanov T. Bacteria-responsive multilayer coatings comprising polycationic nanospheres for bacteria biofilm prevention on urinary catheters. Acta Biomater 2016; 33:203-12. [PMID: 26804206 DOI: 10.1016/j.actbio.2016.01.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 01/13/2016] [Accepted: 01/18/2016] [Indexed: 11/17/2022]
Abstract
This work reports on the development of infection-preventive coatings on silicone urinary catheters that contain in their structure and release on demand antibacterial polycationic nanospheres. Polycationic aminocellulose conjugate was first sonochemically processed into nanospheres to improve its antibacterial potential compared to the bulk conjugate in solution (ACSol). Afterward the processed aminocellulose nanospheres (ACNSs) were combined with the hyaluronic acid (HA) polyanion to build a layer-by-layer construct on silicone surfaces. Although the coating deposition was more effective when HA was coupled with ACSol than with ACNSs, the ACNSs-based coatings were thicker and displayed smoother surfaces due to the embedment of intact nanospheres. The antibacterial effect of ACNSs multilayers was 40% higher compared to ACSol coatings. This fact was further translated into more effective prevention of Pseudomonas aeruginosa biofilm formation. The coatings were stable in the absence of bacteria, whereas their disassembling occurred gradually during incubation with P. aeruginosa, and thus eradicate the biofilm upon release of antibacterial agents. Only 5 bilayers of HA/ACNSs were sufficient to prevent the biofilm formation, in contrast to the 10 bilayers of ACSol required to achieve the same effect. The antibiofilm efficiency of (HA/ACNSs)10 multilayer construct built on a Foley catheter was additionally validated under dynamic conditions using a model of the catheterized bladder in which the biofilm was grown during seven days. STATEMENT OF SIGNIFICANCE Antibacterial layer-by-layer coatings were fabricated on silicone that efficiently prevents Pseudomonas aeruginosa biofilm formation during time beyond the useful lifetime of the currently employed urinary catheters in medical practice. The coatings are composed of intact, highly antibacterial polycationic nanospheres processed from aminated cellulose and bacteria-degrading glycosaminoglycan hyaluronic acid. The importance of incorporating nanoscale structures within bacteria-responsive surface coatings to impart durable antibacterial and self-defensive properties to the medical indwelling devices is highlighted.
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Affiliation(s)
- Antonio Francesko
- Grup de Biotecnologia Molecular i Industrial, Department of Chemical Engineering, Universitat Politècnica de Catalunya, Spain
| | - Margarida M Fernandes
- Grup de Biotecnologia Molecular i Industrial, Department of Chemical Engineering, Universitat Politècnica de Catalunya, Spain
| | - Kristina Ivanova
- Grup de Biotecnologia Molecular i Industrial, Department of Chemical Engineering, Universitat Politècnica de Catalunya, Spain
| | - Sara Amorim
- 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Iva Pashkuleva
- 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ernest Mendoza
- Grup de Nanomaterials Aplicats, Centre de Recerca en Nanoenginyeria, Universitat Politècnica de Catalunya, Spain
| | - Annett Pfeifer
- Center of Excellence for Polysaccharide Research, Institute of Organic Chemistry and Macromolecular Chemistry, Friedrich Schiller University of Jena, Germany
| | - Thomas Heinze
- Center of Excellence for Polysaccharide Research, Institute of Organic Chemistry and Macromolecular Chemistry, Friedrich Schiller University of Jena, Germany
| | - Tzanko Tzanov
- Grup de Biotecnologia Molecular i Industrial, Department of Chemical Engineering, Universitat Politècnica de Catalunya, Spain.
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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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41
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Bacteriophage Can Prevent Encrustation and Blockage of Urinary Catheters by Proteus mirabilis. Antimicrob Agents Chemother 2015; 60:1530-6. [PMID: 26711744 DOI: 10.1128/aac.02685-15] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 12/11/2015] [Indexed: 11/20/2022] Open
Abstract
Proteus mirabilis forms dense crystalline biofilms on catheter surfaces that occlude urine flow, leading to serious clinical complications in long-term catheterized patients, but there are presently no truly effective approaches to control catheter blockage by this organism. This study evaluated the potential for bacteriophage therapy to control P. mirabilis infection and prevent catheter blockage. Representative in vitro models of the catheterized urinary tract, simulating a complete closed drainage system as used in clinical practice, were employed to evaluate the performance of phage therapy in preventing blockage. Models mimicking either an established infection or early colonization of the catheterized urinary tract were treated with a single dose of a 3-phage cocktail, and the impact on time taken for catheters to block, as well as levels of crystalline biofilm formation, was measured. In models of established infection, phage treatment significantly increased time taken for catheters to block (∼ 3-fold) compared to untreated controls. However, in models simulating early-stage infection, phage treatment eradicated P. mirabilis and prevented blockage entirely. Analysis of catheters from models of established infection 10 h after phage application demonstrated that phage significantly reduced crystalline biofilm formation but did not significantly reduce the level of planktonic cells in the residual bladder urine. Taken together, these results show that bacteriophage constitute a promising strategy for the prevention of catheter blockage but that methods to deliver phage in sufficient numbers and within a key therapeutic window (early infection) will also be important to the successful application of phage to this problem.
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Abstract
Interactions between microbes are complex and play an important role in the pathogenesis of infections. These interactions can range from fierce competition for nutrients and niches to highly evolved cooperative mechanisms between different species that support their mutual growth. An increasing appreciation for these interactions, and desire to uncover the mechanisms that govern them, has resulted in a shift from monomicrobial to polymicrobial biofilm studies in different disease models. Here we provide an overview of biofilm models used to study select polymicrobial infections and highlight the impact that the interactions between microbes within these biofilms have on disease progression. Notable recent advances in the development of polymicrobial biofilm-associated infection models and challenges facing the study of polymicrobial biofilms are addressed.
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Affiliation(s)
- Rebecca A Gabrilska
- Departments of Surgery & Immunology & Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Kendra P Rumbaugh
- Departments of Surgery & Immunology & Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
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43
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Urinary catheter capable of repeated on-demand removal of infectious biofilms via active deformation. Biomaterials 2015; 77:77-86. [PMID: 26584348 DOI: 10.1016/j.biomaterials.2015.10.070] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 10/17/2015] [Accepted: 10/26/2015] [Indexed: 12/25/2022]
Abstract
Biofilm removal from biomaterials is of fundamental importance, and is especially relevant when considering the problematic and deleterious impact of biofilm infections on the inner surfaces of urinary catheters. Catheter-associated urinary tract infections are the most common cause of hospital-acquired infections and there are over 30 million Foley urinary catheters used annually in the USA. In this paper, we present the design and optimization of urinary catheter prototypes capable of on-demand removal of biofilms from the inner luminal surface of catheters. The urinary catheters utilize 4 intra-wall inflation lumens that are pressure-actuated to generate region-selective strains in the elastomeric urine lumen, and thereby remove overlying biofilms. A combination of finite-element modeling and prototype fabrication was used to optimize the catheter design to generate greater than 30% strain in the majority of the luminal surface when subjected to pressure. The catheter prototypes are able to remove greater than 80% of a mixed community biofilm of Proteus mirabilis and Escherichia coli on-demand, and furthermore are able to remove the biofilm repeatedly. Additionally, experiments with the prototypes demonstrate that biofilm debonding can be achieved upon application of both tensile and compressive strains in the inner surface of the catheter. The fouling-release catheter offers the potential for a non-biologic, non-antibiotic method to remove biofilms and thereby for impacting the thus far intractable problem of catheter-associated infections.
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Rani SA, Celeri C, Najafi R, Bley K, Debabov D. Irrigation with N,N-dichloro-2,2-dimethyltaurine (NVC-422) in a citrate buffer maintains urinary catheter patency in vitro and prevents encrustation by Proteus mirabilis. Urolithiasis 2015; 44:247-56. [DOI: 10.1007/s00240-015-0811-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
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45
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Thallinger B, Brandauer M, Burger P, Sygmund C, Ludwig R, Ivanova K, Kun J, Scaini D, Burnet M, Tzanov T, Nyanhongo GS, Guebitz GM. Cellobiose dehydrogenase functionalized urinary catheter as novel antibiofilm system. J Biomed Mater Res B Appl Biomater 2015; 104:1448-56. [PMID: 26251187 DOI: 10.1002/jbm.b.33491] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 07/07/2015] [Accepted: 07/18/2015] [Indexed: 11/11/2022]
Abstract
Urinary catheters expose patients to a high risk of acquiring nosocomial infections. To prevent this risk of infection, cellobiose dehydrogenase (CDH), an antimicrobial enzyme able to use various oligosaccharides as electron donors to produce hydrogen peroxide using oxygen as an electron acceptor, was covalently grafted onto plasma-activated urinary polydimethylsiloxane (PDMS) catheter surfaces. Successful immobilization of CDH on PDMS was confirmed by Fourier transformed-infrared spectrometry and production of H2 O2 . The CDH functionalized PDMS surfaces reduced the amount of viable Staphylococcus aureus by 60%, total biomass deposited on the surface by 30% and 70% of biofilm formation. The immobilized CDH was relatively stable in artificial urine over 16 days, retaining 20% of its initial activity. The CDH coated PDMS surface did not affect the growth and physiology of HEK 239 and RAW 264,7 mammalian cells. Therefore this new CDH functionalized catheter system shows great potential for solving the current problems associated with urinary catheters. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1448-1456, 2016.
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Affiliation(s)
- Barbara Thallinger
- Institute of Environmental Biotechnology, University of Natural Resources and Life Sciences, 3430, Tulln, Austria.
| | - Martin Brandauer
- Institute of Environmental Biotechnology, University of Natural Resources and Life Sciences, 3430, Tulln, Austria
| | - Peter Burger
- Institute of Environmental Biotechnology, University of Natural Resources and Life Sciences, 3430, Tulln, Austria
| | - Christoph Sygmund
- Department of Food Sciences and Technology, Food Biotechnology Laboratory, University of Natural Resources and Life Sciences, 1190, Vienna, Austria
| | - Roland Ludwig
- Department of Food Sciences and Technology, Food Biotechnology Laboratory, University of Natural Resources and Life Sciences, 1190, Vienna, Austria
| | - Kristina Ivanova
- Department d'Enginyeria Química, Universitat Politècnica de Catalunya, Grup de Biotecnologia Molecular i Industrial, 08222, Terrassa, Spain
| | - Jutta Kun
- Synovo GesmbH, 72076, Tübingen, Germany
| | - Denis Scaini
- Elettra Sincrotrone, 34149, Basovizza, TS, Italy
| | | | - Tzanko Tzanov
- Department d'Enginyeria Química, Universitat Politècnica de Catalunya, Grup de Biotecnologia Molecular i Industrial, 08222, Terrassa, Spain
| | - Gibson S Nyanhongo
- Institute of Environmental Biotechnology, University of Natural Resources and Life Sciences, 3430, Tulln, Austria. .,Botswana International University of Science and Technology, Private Mail Bag 16, Palapye Botswana.
| | - Georg M Guebitz
- Institute of Environmental Biotechnology, University of Natural Resources and Life Sciences, 3430, Tulln, Austria
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46
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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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47
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Maierl M, Jörger M, Rosker P, Reisner A. In vitro Dynamic Model of a Catheterized Bladder and Biofilm Assay. Bio Protoc 2015; 5:e1381. [PMID: 29082279 DOI: 10.21769/bioprotoc.1381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Biofilm formation on catheters is thought to contribute to persistence of catheter-associated urinary tract infections (CAUTI) which represent the most frequent nosocomial infections. Understanding of factors relevant for CAUTI pathogenesis and evaluation of new therapeutics or interference strategies requires a model system that mirrors the physico-chemical conditions prevailing in a catheterized human bladder. The described in vitro dynamic model of a catheterized bladder enables to emulate many of the characteristics of a catheterized human bladder albeit in the absence of a bladder epithelium. A minor modification compared to the original model system (Stickler, et al., 1999) allows temperature maintenance of the top 10 cm of the catheter, thereby enabling reproducible monitoring of biofilm formation on the internal catheter surface.
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Affiliation(s)
- Mario Maierl
- Biomedical Science, University of Applied Sciences, Graz, Austria
| | - Michael Jörger
- Biomedical Science, University of Applied Sciences, Graz, Austria
| | - Patrik Rosker
- Biomedical Science, University of Applied Sciences, Graz, Austria
| | - Andreas Reisner
- Biomedical Science, University of Applied Sciences, Graz, Austria
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48
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Bacteriophage-mediated control of a two-species biofilm formed by microorganisms causing catheter-associated urinary tract infections in an in vitro urinary catheter model. Antimicrob Agents Chemother 2014; 59:1127-37. [PMID: 25487795 DOI: 10.1128/aac.03786-14] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Microorganisms from a patient or their environment may colonize indwelling urinary catheters, forming biofilm communities on catheter surfaces and increasing patient morbidity and mortality. This study investigated the effect of pretreating hydrogel-coated silicone catheters with mixtures of Pseudomonas aeruginosa and Proteus mirabilis bacteriophages on the development of single- and two-species biofilms in a multiday continuous-flow in vitro model using artificial urine. Novel phages were purified from sewage, characterized, and screened for their abilities to reduce biofilm development by clinical isolates of their respective hosts. Our screening data showed that artificial urine medium (AUM) is a valid substitute for human urine for the purpose of evaluating uropathogen biofilm control by these bacteriophages. Defined phage cocktails targeting P. aeruginosa and P. mirabilis were designed based on the biofilm inhibition screens. Hydrogel-coated catheters were pretreated with one or both cocktails and challenged with approximately 1×10(3) CFU/ml of the corresponding pathogen(s). The biofilm growth on the catheter surfaces in AUM was monitored over 72 to 96 h. Phage pretreatment reduced P. aeruginosa biofilm counts by 4 log10 CFU/cm2 (P≤0.01) and P. mirabilis biofilm counts by >2 log10 CFU/cm2 (P≤0.01) over 48 h. The presence of P. mirabilis was always associated with an increase in lumen pH from 7.5 to 9.5 and with eventual blockage of the reactor lines. The results of this study suggest that pretreatment of a hydrogel urinary catheter with a phage cocktail can significantly reduce mixed-species biofilm formation by clinically relevant bacteria.
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Levering V, Wang Q, Shivapooja P, Zhao X, López GP. Soft robotic concepts in catheter design: an on-demand fouling-release urinary catheter. Adv Healthc Mater 2014; 3:1588-96. [PMID: 24668920 DOI: 10.1002/adhm.201400035] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 02/24/2014] [Indexed: 01/12/2023]
Abstract
Infectious biofilms are problematic in many healthcare-related devices and are especially challenging and ubiquitous in urinary catheters. This report presents an on-demand fouling-release methodology to mechanically disrupt and remove biofilms, and proposes this method for the active removal of infectious biofilms from the previously inaccessible main drainage lumen of urinary catheters. Mature Proteus mirabilis crystalline biofilms detach from silicone elastomer substrates upon application of strain to the substrate, and increasing the strain rate increases biofilm detachment. The study presents a quantitative relationship between applied strain rate and biofilm debonding through an analysis of biofilm segment length and the driving force for debonding. Based on this mechanism, hydraulic and pneumatic elastomer actuation is used to achieve surface strain selectively within the lumen of prototypes of sections of a fouling-release urinary catheter. Proof-of-concept prototypes of sections of active, fouling-release catheters are constructed using techniques typical to soft robotics including 3D printing and replica molding, and those prototypes demonstrate release of mature P. mirabilis crystalline biofilms (e.g., ≈90%) from strained surfaces. These results provide a basis for the development of a new urinary catheter technology in which infectious biofilms are effectively managed through new methods that are entirely complementary to existing approaches.
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Affiliation(s)
- Vrad Levering
- Research Triangle MRSEC; Duke University; Durham NC 27708 USA
- Department of Biomedical Engineering; Duke University; Durham NC 27708 USA
| | - Qiming Wang
- Research Triangle MRSEC; Duke University; Durham NC 27708 USA
- Department of Mechanical Engineering and Materials Science; Duke University; Durham NC 27708 USA
| | | | - Xuanhe Zhao
- Department of Biomedical Engineering; Duke University; Durham NC 27708 USA
- Department of Mechanical Engineering and Materials Science; Duke University; Durham NC 27708 USA
| | - Gabriel P. López
- Research Triangle MRSEC; Duke University; Durham NC 27708 USA
- Department of Biomedical Engineering; Duke University; Durham NC 27708 USA
- Department of Mechanical Engineering and Materials Science; Duke University; Durham NC 27708 USA
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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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