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AbdelRazek M, Mohamed O, Ashour R, Alemam M, El-Gelany M, Abdel-Kader MS. Effect of co-trimoxazole and N-acetylcysteine alone and in combination on bacterial adherence on ureteral stent surface. Urolithiasis 2023; 52:11. [PMID: 38079000 PMCID: PMC10713751 DOI: 10.1007/s00240-023-01508-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023]
Abstract
To assess the effect of co-trimoxazole and N-acetylcysteine (NAC), alone and in combination, on bacterial adherence to biofilm formed on ureteral stent surfaces. This prospective randomized study was conducted on 636 patients who underwent double J ureteral stent insertion after variable urological procedures. Patients were randomized into four groups: A (n = 165), no antibiotics or mucolytics during stent indwelling; B (n = 153), oral NAC (200 mg/day for children aged < 12 years old and 600 mg/day for adults) during stent indwelling; C (n = 162), oral co-trimoxazole (2 mg TMP/kg/day) during stent indwelling; and D (n = 156), both oral NAC and co-trimoxazole during stent indwelling. Two weeks following double J stent (JJ stent) insertion, urinalysis was performed on all patients and urine culture was done for all the patients at the day of double J stent removal. The stent was removed 2 weeks postoperatively, and a stent segment sized 3-5 cm from the bladder segment of the stent was sent for culture. Positive stent cultures were found in 63.6% (105/165), 43.1% (66/153), 37% (60/162), and 19.2% (30/156) patients of groups A, B, C, and D, respectively. E. coli was the organism most commonly isolated from the stent culture in all groups. The combination of co-trimoxazole and NAC was more effective in reducing bacterial adherence on ureteral stent surfaces than either alone.
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Affiliation(s)
- Mostafa AbdelRazek
- Department of Urology, Qena University Hospital, Faculty of Medicine, South Valley University, P.O. Box 83523, Qena, Egypt.
| | - Omar Mohamed
- Department of Urology, Qena University Hospital, Faculty of Medicine, South Valley University, P.O. Box 83523, Qena, Egypt
| | - Reham Ashour
- Department of Clinical Pathology, Qena University Hospital, South Valley University, Qena, Egypt
| | - Mohamed Alemam
- Department of Clinical Pathology, Qena University Hospital, South Valley University, Qena, Egypt
| | - Mohamed El-Gelany
- Department of Urology, Qena University Hospital, Faculty of Medicine, South Valley University, P.O. Box 83523, Qena, Egypt
| | - Mohammed S Abdel-Kader
- Department of Urology, Qena University Hospital, Faculty of Medicine, South Valley University, P.O. Box 83523, Qena, Egypt
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Li Y, Jiang L, Luo S, Hu D, Zhao X, Zhao G, Tang W, Guo Y. Analysis of Characteristics, Pathogens and Drug Resistance of Urinary Tract Infection Associated with Long-Term Indwelling Double-J Stent. Infect Drug Resist 2023; 16:2089-2096. [PMID: 37063938 PMCID: PMC10094401 DOI: 10.2147/idr.s392857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/21/2023] [Indexed: 04/18/2023] Open
Abstract
Objective To investigate the characteristics, pathogens and drug resistance of urinary tract infection (UTI) associated with long-term indwelling double-J stent. Methods The clinical data of 102 patients with urinary tract infection associated with long-term indwelling double-J stent in University-Town Hospital of Chongqing Medical University and Chongqing Traditional Chinese Medicine Hospital from September 2010 to July 2022 were collected retrospectively, and the difference between etiological characteristics were analyzed. Urine and double-J stent samples of patients were collected for pathogen identification and drug sensitivity test. Results A total of 102 patients, 39 (38.23%) males and 63 (61.77%) females, aged 24-72 years, with a median age of 48 years, were included in this study. Urinary calculi (40.20%) and ureteral stricture (24.50%) were the main causes of urinary tract infection associated with long-term indwelling double-J stent. Among the patients with urinary tract infection caused by double-J stent, female patients were higher than male patients (61.77% vs 38.23%). In terms of positive rate of pathogenic bacteria culture, the rate of double-J stent was higher than that of urine (67.65% vs 35.29%). The main pathogenic bacteria in urine were Escherichia coli (30.55%) of Gram negative bacteria, while the main pathogenic bacteria in double-J stent were enterococcus faecalis (27.53%) of Gram positive bacteria. The resistance rate of Gram positive bacteria in double-J stent to vancomycin, ciprofloxacin, meropenem and piperacillin/tazobactam was significantly higher than that in urine (P<0.05). The resistance rate of Gram negative bacteria in double-J stent to imipenem, cefepime, piperacillin/tazobactam, meropenem and cefoperazone/sulbactam was significantly higher than that in urine (P<0.05). Conclusion Double-J stent associated urinary tract infection is more common in women than in men. Escherichia coli and Enterococcus faecalis are the main pathogens, and the pathogens show strong drug resistance.
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Affiliation(s)
- Yuehua Li
- Department of Urology, University-Town Hospital of Chongqing Medical University, Chongqing, 400000, People’s Republic of China
| | - Li Jiang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, People’s Republic of China
| | - Shengjun Luo
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, People’s Republic of China
| | - Daixing Hu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, People’s Republic of China
| | - Xin Zhao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, People’s Republic of China
| | - Guozhi Zhao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, People’s Republic of China
| | - Wei Tang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, People’s Republic of China
| | - Yu Guo
- Department of Urology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400000, People’s Republic of China
- Correspondence: Yu Guo, Department of Urology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400000, People’s Republic of China, Tel/Fax +8623 67665886, Email
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Vrijsen E, Devriendt N, Mortier F, Stock E, Van Goethem B, de Rooster H. Complications and survival after subcutaneous ureteral bypass device placement in 24 cats: a retrospective study (2016-2019). J Feline Med Surg 2021; 23:759-769. [PMID: 33231515 PMCID: PMC10812192 DOI: 10.1177/1098612x20975374] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to document survival, complications and risk factors for the development of complications and mortality prior to discharge after placement of a subcutaneous ureteral bypass (SUB) device in cats. METHODS The medical records of cats with SUB placement between January 2016 and August 2019 were retrospectively analysed. The development of complications (overall, intraoperative, perioperative, short- and long-term complications) and risk factors for mortality prior to discharge were statistically assessed with univariate binary logistic regression. All variables with a P value ⩽0.10 in the univariate analysis were assessed in a multivariate model. Variables were significant if P <0.05. RESULTS Twenty-four cats were included; 12 (50.0%) received a unilateral SUB, 11 (45.8%) a bilateral nephrostomy tube with single cystostomy catheter and the remaining cat (4.2%) two unilateral SUBs. Nearly 80% of the cats developed complications, ranging from mild to fatal, including (partial) SUB obstruction (33.3% of complications), lower urinary tract infection (20.8%), pyelonephritis (20.8%) and sterile cystitis (12.5%). Five cats (20.8%) died prior to discharge. Six cats (25.0%) underwent revision surgery. The overall median survival time (MST) was 274 days (range 1-311 days). Complications were most common in the long-term period (14/16 cats), followed by the short-term (9/18 cats), perioperative (10/23 cats) and intraoperative (4/24 cats) periods. Older cats had an increased risk for developing perioperative complications (P = 0.045) and were less likely to survive to discharge (P = 0.033). An increased haematocrit at presentation was a risk factor for the occurrence of short-term complications (P = 0.03). CONCLUSIONS AND RELEVANCE Although complications similar to those previously described were observed, the complication rate was higher and the MST shorter than previously reported in cats undergoing SUB placement. Despite good short-term survival, the development of complications may necessitate regular and intensive control visits. Owners that consider SUB placement should be informed that follow-up can be strenuous and expensive.
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Affiliation(s)
- Emily Vrijsen
- Small Animal Department, Ghent University, Merelbeke, Belgium
- Department of Clinical Sciences (Companion Animals and Equidae), University of Liège, Sart-Tilman, Belgium
| | | | - Femke Mortier
- Small Animal Department, Ghent University, Merelbeke, Belgium
| | - Emmelie Stock
- Department of Medical Imaging of Domestic Animals and Orthopaedics of Small Animals, Ghent University, Merelbeke, Belgium
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Petrovsky B, Berent AC, Weisse CW, Branter E, Bagley DH, Lamb KE. Endoscopic nephrolithotomy for the removal of complicated nephroliths in dogs and cats: 16 kidneys in 12 patients (2005-2017). J Am Vet Med Assoc 2020; 255:352-365. [PMID: 31298636 DOI: 10.2460/javma.255.3.352] [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: 11/20/2022]
Abstract
OBJECTIVE To describe techniques and outcomes for dogs and cats undergoing endoscopic nephrolithotomy (ENL) for the removal of complicated nephroliths. ANIMALS 11 dogs and 1 cat (n = 16 renal units) with complicated nephroliths that underwent ENL via a surgically assisted ENL approach (12 renal units) or a percutaneous nephrolithotomy approach (4 renal units) between December 2005 and June 2017. PROCEDURES Data were obtained from the medical records regarding preoperative, operative, and postoperative findings. Follow-up information on complications and outcomes was also collected. RESULTS Indications for nephrolith removal included massive calculi displacing parenchyma (n = 7), recurrent urinary tract infections (5), and ureteral outflow obstruction (4). Median nephrolith diameter was 2.5 cm (range, 0.5 to 5.7 cm). Nephrolith composition differed among patients; calcium oxalate was the most common type (n = 7 [including 2 mixed nephroliths containing ≥ 60% calcium oxalate]). Following ENL (median duration, 180 minutes), 15 of 16 renal units were completely nephrolith free. Procedure-related complications included renal puncture-associated hemorrhage requiring a blood transfusion (n = 1), renal capsule tear (1), and ureteral puncture (1); all were managed without adverse consequence. Five of 12 patients remained alive at the final follow-up (median, 557 days after ENL), and none died from the procedure. CONCLUSIONS AND CLINICAL RELEVANCE ENL as performed was safe and effective in removing complicated nephroliths in a renal-sparing manner for the patients in this study. This procedure requires technical training and could be considered for the treatment of complicated nephrolithiasis in dogs and possibly cats.
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Milligan ML, Berent AC, Weisse CW, Lamb K, Toizer E. Outcome of SUB placement for the treatment of benign ureteral obstruction in dogs: nine dogs and 12 renal units (2013 to 2017). J Small Anim Pract 2020; 61:428-435. [PMID: 32352170 DOI: 10.1111/jsap.13137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 01/07/2020] [Accepted: 03/01/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe a group of dogs with benign ureteral obstruction(s) treated by subcutaneous ureteral bypass and report the intra-operative, peri-operative, short- and long-term outcomes. MATERIALS AND METHODS Review of medical records of dogs that underwent subcutaneous ureteral bypass. RESULTS Nine dogs (12 renal units) were included. Causes of obstruction included: ureterolithiasis (n=9) extraluminal compression (n=2), and stricture (n=1). Eleven of 12 ureters had a previously placed stent and required subcutaneous ureteral bypass for: recurrent stricture (n=4), diffuse ureteritis (n=4) or stent migration (n=3). Placement was successful in all renal units and there were no peri-operative or procedure-related deaths. Median hospitalisation time was 3 days. The median creatinine values pre-operatively and 3 month post-operatively were 186 and 106 μmol/L, respectively. No dog had worsening azotaemia in the short-term. The most common long-term complication was mineralisation of six devices, of which four required exchange. All dogs that were infected post-operatively (n=5) had a history of at least one urinary tract infection pre-operatively. One of the nine dogs had a chronic post-operative urinary tract infection and had been chronically infected before placing the bypass. The median survival time was >774 days, with five of nine dogs alive at the time of publication. CLINICAL SIGNIFICANCE Placement of a subcutaneous ureteral bypass was an effective short-term treatment option for benign ureteral obstructions in dogs but there was a high rate of device mineralisation.
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Affiliation(s)
- M L Milligan
- Department of Interventional Radiology and Endoscopy, The Animal Medical Center, New York, NY, 10065, USA
| | - A C Berent
- Department of Interventional Radiology and Endoscopy, The Animal Medical Center, New York, NY, 10065, USA
| | - C W Weisse
- Department of Interventional Radiology and Endoscopy, The Animal Medical Center, New York, NY, 10065, USA
| | - K Lamb
- Lamb Consulting, West St. Paul, MN, 55118, USA
| | - E Toizer
- Lamb Consulting, West St. Paul, MN, 55118, USA
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Ma Z, Gao M, Na D, Li Y, Tan L, Yang K. Study on a biodegradable antibacterial Fe-Mn-C-Cu alloy as urinary implant material. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 103:109718. [PMID: 31349483 DOI: 10.1016/j.msec.2019.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/13/2019] [Accepted: 05/02/2019] [Indexed: 11/30/2022]
Abstract
Biodegradable Fe based alloys have been investigated for fracture fixation and cardiovascular support to overcome complications of permanent implants. This study was focused on the development of a new Fe-Mn-C-Cu alloy with antibacterial and anti-encrustation properties as a urinary implant material. The microstructure and mechanical properties of the alloy were studied. The degradation behavior, antibacterial and anti-encrustation properties were evaluated by immersion test, antibacterial test and encrustation test, respectively. The results showed that Fe-Mn-C-Cu alloy was a non-magnetic, biodegradable, anti-bacterial and anti-encrustation alloy that could inhibit the biofilm and stone formations on its surface through the dual effects of degradation and Cu ions release. The study revealed the preliminary mechanisms of anti-infection and anti-encrustation for Fe-Mn-C-Cu alloy due to the continuous release of Cu2+ ions, which provides a new idea for application of biodegradable Fe-based material and the treatment of urinary tract infections and stones in the urinary system.
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Affiliation(s)
- Zheng Ma
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
| | - Ming Gao
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China; School of Materials Science and Engineering, University of Science and Technology of China, Shenyang, China
| | - Di Na
- First Affiliated Hospital of China Medical University, Department of Surgical Oncology, China
| | - Yangde Li
- Dongguan Eontech Co., Ltd, Dongguan 523662, China
| | - Lili Tan
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China.
| | - Ke Yang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China.
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Berent AC, Weisse CW, Bagley DH, Lamb K. Use of a subcutaneous ureteral bypass device for treatment of benign ureteral obstruction in cats: 174 ureters in 134 cats (2009–2015). J Am Vet Med Assoc 2018; 253:1309-1327. [DOI: 10.2460/javma.253.10.1309] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Livet V, Pillard P, Goy-Thollot I, Maleca D, Cabon Q, Remy D, Fau D, Viguier É, Pouzot C, Carozzo C, Cachon T. Placement of subcutaneous ureteral bypasses without fluoroscopic guidance in cats with ureteral obstruction: 19 cases (2014-2016). J Feline Med Surg 2017; 19:1030-1039. [PMID: 27694368 PMCID: PMC11110986 DOI: 10.1177/1098612x16670572] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The purpose of this study was to describe the perioperative and postoperative complications as well as short-term and long-term outcomes in cats with ureteral obstructions treated by placement of a subcutaneous ureteral bypass (SUB) device without imaging control. The second objective of this study was to compare cats treated by SUB device with cats treated by traditional surgical intervention. Methods Data were obtained retrospectively from the medical records (2014-2016) of cats that underwent SUB placement (SUB cats) and cats that underwent traditional ureteral surgery (C cats). Results Nineteen SUB devices were placed without fluoroscopic, radiographic or ultrasonographic guidance in 13 cats. Fifteen traditional interventions (ureterotomy and neoureterocystostomy) were performed in 11 cats. Successful placement of the SUB device was achieved in all cats with only one major intraoperative complication (kinking of the kidney catheter) and one minor intraoperative complication (misplacement of the kidney catheter). Eleven SUB cats recovered from the surgical procedure; two SUB cats and three C cats died during the anaesthesia recovery period. Postoperative SUB complications included anaemia (n = 2), urinary tract infection (UTI) (n = 4), non-infectious cystitis (n = 5) and SUB device obstruction (n = 1). Postoperative traditional surgery complications included anaemia (n = 7), UTIs (n = 6), non-infectious cystitis (n = 1), re-obstruction (n = 4) and ureteral stricture (n = 1). Median postoperative duration of hospitalisation (3 days) was significantly shorter for SUB cats than for C cats ( P = 0.013). Ten SUB cats (76.9%) and four C cats (40%) were still alive at a median follow-up of 225 days and 260 days, respectively. Owners were completely (90%) or mostly (10%) satisfied with the SUB device placement. Conclusions and relevance SUB device placement appears to be an effective and safe option for treating ureteral obstruction in cats, and this study has shown that fluoroscopic guidance is not essential in all cases.
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Affiliation(s)
- Véronique Livet
- Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
- Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
| | - Paul Pillard
- Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
- Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
| | - Isabelle Goy-Thollot
- SIAMU Intensive Care Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
- APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
| | - David Maleca
- Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
- Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
| | - Quentin Cabon
- Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
- Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
| | - Denise Remy
- Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
- Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
| | - Didier Fau
- Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
- Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
| | - Éric Viguier
- Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
- Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
| | - Céline Pouzot
- SIAMU Intensive Care Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
- APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
| | - Claude Carozzo
- Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
- Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
| | - Thibaut Cachon
- Surgery Unit, Lyon Veterinary Teaching Hospital, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
- Research Unit ICE, UPSP 2011.03.101, Université de Lyon, Veterinary Campus of VetAgro Sup, Marcy l’Etoile, France
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Sarier M, Demir M, Duman I, Yuksel Y, Demirbas A. Evaluation of Ureteral Stent Colonization in Live-Donor Renal Transplant Recipients. Transplant Proc 2017; 49:415-419. [DOI: 10.1016/j.transproceed.2017.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vachon C, Defarges A, Brisson B, Nykamp S, Weese JS, Denstedt J, Berent AC. Passive ureteral dilation and ureteroscopy after ureteral stent placement in five healthy Beagles. Am J Vet Res 2017; 78:381-392. [DOI: 10.2460/ajvr.78.3.381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ghanbarzadeh Corehtash Z, Khorshidi A, Firoozeh F, Akbari H, Mahmoudi Aznaveh A. Biofilm Formation and Virulence Factors Among Pseudomonas aeruginosa Isolated From Burn Patients. Jundishapur J Microbiol 2015; 8:e22345. [PMID: 26587205 PMCID: PMC4644346 DOI: 10.5812/jjm.22345] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 11/20/2014] [Accepted: 12/19/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa possesses a variety of virulence factors and infections caused by multidrug-resistant P. aeruginosa (MDRPA) in burn patients are a public health problem. OBJECTIVES The aim of this study was to determine the antibiotic resistance pattern, the biofilm formation, the prevalence of MDRPA and two virulence genes (nan1 and exoA) among P. aeruginosa isolated from burn patients. PATIENTS AND METHODS A total of 144 isolates of P. aeruginosa were collected from burn patient at the Burn Centre of Tehran, Iran, between March 2013 and July 2013. Antibiotic susceptibility test was performed via agar disk diffusion method. The ability of producing biofilm was examined by crystal violet microtiter plate assay and the prevalence of the exoA and nan1 genes among the isolates was determined by polymerase chain reaction (PCR). RESULTS A high rate of resistance was seen against ciprofloxacin (93.7%), aztreonam (86.8%), piperacillin (85.4%), ceftazidime (82.6%), amikacin (82%) and imipenem (79.2%). In total, 93.1% of the isolates were characterized as MDRPA. Biofilm formation was seen in 92.4% of the isolates. The prevalence of the exoA and nan1 genes were 75% and 11.8% among the isolates, respectively. CONCLUSIONS The high rate of MDRPA and its ability to produce biofilm is an alarm for public health. The statistical analysis showed that biofilm production in the MDRPA isolates was significantly higher than that in the non-MDRPA isolates (P < 0.001).
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Affiliation(s)
- Zahra Ghanbarzadeh Corehtash
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Ahmad Khorshidi
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Ahmad Khorshidi, Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-9133624687, Fax: +98-3615551112, E-mail:
| | - Farzaneh Firoozeh
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Hosein Akbari
- Biostatistics Department, Truma Research center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Azam Mahmoudi Aznaveh
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
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Steinhaus J, Berent A, Weisse C, Eatroff A, Donovan T, Haddad J, Bagley D. Clinical presentation and outcome of cats with circumcaval ureters associated with a ureteral obstruction. J Vet Intern Med 2015; 29:63-70. [PMID: 25270055 PMCID: PMC4858092 DOI: 10.1111/jvim.12465] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/24/2014] [Accepted: 08/25/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Circumcaval ureters (CU) are a rare embryological malformation resulting in ventral displacement of the caudal vena cava, which crosses the ureter, potentially causing a ureteral stricture. OBJECTIVES To evaluate cats with obstructed CU(s) and report the presenting signs, diagnostics, treatment(s), and outcomes. Cats with obstructed CU(s) were compared to ureterally obstructed cats without CU(s). ANIMALS 193 cats; 22 circumcaval obstructed (Group 1); 106 non-circumcaval obstructed (Group 2); 65 non-obstructed necropsy cases (Group 3). METHODS Retrospective study, review of medical records for cats treated for benign ureteral obstructions from AMC and University of Pennsylvania between 2009 and 2013. INCLUSION CRITERIA surgical treatment of benign ureteral obstruction, complete medical record including radiographic, ultrasonographic, biochemistry, and surgical findings. RESULTS Seventeen percent (22/128) of obstructed cats had a CU (80% right-sided) compared to 14% (9/65) non-obstructed necropsy cats (89% right-sided). Clinical presentation, radiographic findings, and creatinine were not statistically different between Groups 1 and 2. Strictures were a statistically more common (40%) cause of ureteral obstruction in Group 1 compared to Group 2 (17%) (P = .01). The MST for Groups 1 and 2 after ureteral decompression was 923 and 762 days, respectively (P = .62), with the MST for death secondary to kidney disease in both groups being >1,442 days. Re-obstruction was the most common complication in Group 1 (24%) occurring more commonly in ureters of cats treated with a ureteral stent(s) (44%) compared to the subcutaneous ureteral bypass (SUB) device (8%) (P = .01). CONCLUSIONS AND CLINICAL IMPORTANCE Ureteral obstructions in cats with a CU(s) have a similar outcome to those cats with a ureteral obstruction and normal ureteral anatomy. Long-term prognosis is good for benign ureteral obstructions treated with a double pigtail stent or a SUB device. The SUB device re-obstructed less commonly than the ureteral stent, especially when a ureteral stricture was present.
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Affiliation(s)
- J. Steinhaus
- Department of Interventional Radiology and EndoscopyThe AMCNew YorkNY
| | - A.C. Berent
- Department of Interventional Radiology and EndoscopyThe AMCNew YorkNY
| | - C. Weisse
- Department of Interventional Radiology and EndoscopyThe AMCNew YorkNY
| | - A. Eatroff
- Department of Internal MedicineBluePearl Veterinary PartnersNew YorkNY
| | - T. Donovan
- Department of Anatomic PathologyThe AMCNew YorkNY
| | - J. Haddad
- Department of Anatomic and Clinical PathologyIdexx LaboratoriesNew YorkNY
| | - D. Bagley
- Thomas Jefferson UniversityPhiladelphiaPA
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14
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In vitro cytotoxic effects of gold nanoparticles coated with functional acyl homoserine lactone lactonase protein from Bacillus licheniformis and their antibiofilm activity against Proteus species. Antimicrob Agents Chemother 2014; 59:763-71. [PMID: 25403677 DOI: 10.1128/aac.03047-14] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
N-acylated homoserine lactonases are known to inhibit the signaling molecules of the biofilm-forming pathogens. In this study, gold nanoparticles were coated with N-acylated homoserine lactonase proteins (AiiA AuNPs) purified from Bacillus licheniformis. The AiiA AuNPs were characterized by UV-visible spectra, Fourier transform infrared spectroscopy (FTIR), transmission electron microscopy (TEM), and X-ray diffraction (XRD). The synthesized AiiA AuNPs were found to be spherical in shape and 10 to 30 nm in size. Treatment with AiiA protein-coated AuNPs showed maximum reduction in exopolysaccharide production, metabolic activities, and cell surface hydrophobicity and potent antibiofilm activity against multidrug-resistant Proteus species compared to treatment with AiiA protein alone. AiiA AuNPs exhibited potent antibiofilm activity at 2 to 8 μM concentrations without being harmful to the macrophages. We conclude that at a specific dose, AuNPs coated with AiiA can kill bacteria without harming the host cells, thus representing a potential template for the design of novel antibiofilm and antibacterial protein drugs to decrease bacterial colonization and to overcome the problem of drug resistance. In summary, our data suggest that the combined effect of the lactonase and the gold nanoparticles of the AiiA AuNPs has promising antibiofilm activity against biofilm-forming and multidrug-resistant Proteus species.
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15
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Chatterjee S, Maiti P, Dey R, Kundu A, Dey R. Biofilms on indwelling urologic devices: microbes and antimicrobial management prospect. Ann Med Health Sci Res 2014; 4:100-4. [PMID: 24669340 PMCID: PMC3952279 DOI: 10.4103/2141-9248.126612] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Biofilms (BFs) are a potential source of highly resistant infections, frequently formed on devicesand pose problems for management. AIM This study was to develop rational approach for prevention of indwelling urologic device associated biofilm colonization. SUBJECTS AND METHODS From randomly selected patients visiting Department of Urology of a tertiary hospital in India 150 uro catheters and 31 used ureteric stents, in-situ for > 30, were collected aseptically. The organisms were isolated and identified from washed devices dipped in broth. Evidence of bacteriuria in each case was checked by semi-quantitative method of urine culture, on day 0 and 14 of device use. The BF statuses of the device-adhered organisms were confirmed by modified method of Christensen. The antibiotic susceptibility was determined by disc diffusion method. Data were analyzed using the Graphpad Prism version 5 statistical software. RESULTS Both single and multi-species BFs were formed on catheters, whereas mono-bacterial BFs were exclusive on stents. Predominant organisms were Pseudomonas aeruginosa (30.67%,69/225,) followed by Staphylococcus aureus (15.11%, 34/225), Escherichia coli (13.78%, 31/225), Klebsiella pneumoniae (12%, 27/225), Staphylococcus epidermidis (8.44%, 19/225). Of all strains, (89.33%, 201/225) were found to be BF positive and their colonizations were early indicated by the presence of insignificant bacteriuria in follow-up urine samples. All BF isolates were resistant to at least three antibiotics. CONCLUSIONS BF colonization was almost inevitable in prolonged used urinary devices and the most frequent organisms were Pseudomonas, Staphylococcus, and Escherichia spp. Their colonizations usually were indicated by insignificant bacteriuria from follow-up samples. Such BF dislodged organisms were multidrug resistant and could be a source of disseminated infection, yet were in-vitro preventable by many drugs.
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Affiliation(s)
- S Chatterjee
- Department of Microbiology, Institute of Post Graduate Medical Education and Research, Bhawanipur, West Bengal, India
| | - Pk Maiti
- Department of Microbiology, Institute of Post Graduate Medical Education and Research, Bhawanipur, West Bengal, India
| | - R Dey
- Department of Microbiology, Institute of Post Graduate Medical Education and Research, Bhawanipur, West Bengal, India
| | - Ak Kundu
- Department of Urology, Institute of Post Graduate Medical Education and Research, Bhawanipur, West Bengal, India
| | - Rk Dey
- Department of Urology, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
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16
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Chew BH, Duvdevani M, Denstedt JD. New developments in ureteral stent design, materials and coatings. Expert Rev Med Devices 2014; 3:395-403. [PMID: 16681460 DOI: 10.1586/17434440.3.3.395] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ureteral stents are used in a variety of urological diseases and procedures. The majority of patients with indwelling ureteral stents experience bothersome symptoms and are at increased risk for urinary tract infection. Stent encrustation and the associated complications can also result in significant patient morbidity. The development of new stent designs using novel biomaterials, stent coatings and drug-eluting technologies are being applied to reduce the disadvantageous features of ureteral stents.
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Affiliation(s)
- Ben H Chew
- University of British Columbia, Division of Urology, Vancouver General Hospital, D419 - Heather Pavilion, D-9, 2733 Heather St., Vancouver, BC V5Z 3J5, Canada
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17
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Rosman BM, Barbosa JABA, Passerotti CP, Cendron M, Nguyen HT. Evaluation of a novel gel-based ureteral stent with biofilm-resistant characteristics. Int Urol Nephrol 2013; 46:1053-8. [PMID: 24366763 DOI: 10.1007/s11255-013-0636-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 12/16/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Current ureteral stents, while effective at maintaining a ureteral lumen, provide a substrate for bacterial growth. This propensity for biofilm formation may be a nidus for bacterial growth leading to infection and a reason for early removal of a stent before it is clinically indicated. A newly devised stent, composed of a highly hydrated, partially hydrolyzed polyacrylonitrile polymer, is believed to have bacterial resistant properties. The objective of this study is to evaluate the biofilm growth and bacterial resistant properties of this novel stent. MATERIALS AND METHODS Multiple 1 cm sections of the pAguaMedicina™ Pediatric Ureteral Stent (pAMS) (Q Urological, Natick, MA) and the conventional polymer stent (SS) (Boston Scientific, Natick, MA) were incubated for 3 days in the 3 different growth media. Afterward, J96 human pathogenic Escherichia coli was added. At 3, 6, 9, 12, and 15 days following bacterial inoculation, the stent segments were washed, sonicated, and analyzed for bacterial growth. Scanning electron microscopy (SEM) imaging was performed to assess biofilm formation. RESULTS pAMS demonstrated significant reductions (43-71 %) in bacterial counts when compared to standard stents in all conditions tested. SEM imaging demonstrated biofilm formation on both types of stents in all media, with a relative reduction in apparent cell debris and bacteria on the pAMS. CONCLUSIONS In this study, the gel-based stent shows a demonstrable reduction in bacterial counts and biofilm formation. The use of the pAMS may reduce the risk of infection associated with stent usage.
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Affiliation(s)
- Brian M Rosman
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell-353, Boston, MA, 02115, USA
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18
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Tenke P, Köves B, Nagy K, Hultgren SJ, Mendling W, Wullt B, Grabe M, Wagenlehner FME, Cek M, Pickard R, Botto H, Naber KG, Bjerklund Johansen TE. Update on biofilm infections in the urinary tract. World J Urol 2011; 30:51-7. [PMID: 21590469 DOI: 10.1007/s00345-011-0689-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 04/22/2011] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Biofilm infections have a major role in implants or devices placed in the human body. As part of the endourological development, a great variety of foreign bodies have been designed, and with the increasing number of biomaterial devices used in urology, biofilm formation and device infection is an issue of growing importance. METHODS A literature search was performed in the Medline database regarding biofilm formation and the role of biofilms in urogenital infections using the following items in different combinations: "biofilm," "urinary tract infection," "bacteriuria," "catheter," "stent," and "encrustation." The studies were graded using the Oxford Centre for Evidence-based Medicine classification. RESULTS The authors present an update on the mechanism of biofilm formation in the urinary tract with special emphasis on the role of biofilms in lower and upper urinary tract infections, as well as on biofilm formation on foreign bodies, such as catheters, ureteral stents, stones, implants, and artificial urinary sphincters. The authors also summarize the different methods developed to prevent biofilm formation on urinary foreign bodies. CONCLUSIONS Several different approaches are being investigated for preventing biofilm formation, and some promising results have been obtained. However, an ideal method has not been developed. Future researches have to aim at identifying effective mechanisms for controlling biofilm formation and to develop antimicrobial agents effective against bacteria in biofilms.
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Affiliation(s)
- Peter Tenke
- Department of Urology, South-Pest Hospital, 1 Koves Str., 1204, Budapest, Hungary.
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19
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Naves P, Del Prado G, Ponte C, Soriano F. Differences in the in vitro susceptibility of planktonic and biofilm-associated Escherichia coli strains to antimicrobial agents. J Chemother 2011; 22:312-7. [PMID: 21123153 DOI: 10.1179/joc.2010.22.5.312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The in vitro susceptibility of seven Escherichia coli biofilm-producing strains in their planktonic and biofilm-associated forms to amoxicillin, amoxicillin/clavulanic acid, cefotaxime, gentamicin, and ciprofloxacin was studied. Minimum inhibitory concentrations (MICs) were determined by the standard microdilution method and by the Alamar blue assay (providing the AB-MIC) at two levels of metabolic suppression and using standard and large inocula. Minimal biofilm inhibitory concentrations (AB-MBICs) on preformed biofilms on polystyrene plates were higher than the MICs and AB-MICs. Differences in magnitude depended on the antibiotic, strain, inoculum size, and the level of suppression of metabolism. Ciprofloxacin and gentamicin showed the greatest differences in the AB-MBIC as compared to AB-MIC. the possibility of antibiotic-resistant mutant selection within the biofilms was ruled out since bacteria recovered from the biofilm maintained the same MICs as before exposure to the antimicrobial agents. E. coli biofilms were much less sensitive than their planktonic counterparts.
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Affiliation(s)
- P Naves
- Department of Medical Microbiology and Antimicrobial Chemotherapy, Fundación Jiménez Díaz, Madrid, Spain.
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20
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Rafat C, Vimont S, Ancel P, Xu-Dubois Y, Mesnard L, Ouali N, Denis M, Vandewalle A, Rondeau E, Hertig A. Ofloxacin: new applications for the prevention of urinary tract infections in renal graft recipients. Transpl Infect Dis 2011; 13:344-52. [DOI: 10.1111/j.1399-3062.2011.00602.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Lange D, Elwood CN, Choi K, Hendlin K, Monga M, Chew BH. Uropathogen interaction with the surface of urological stents using different surface properties. J Urol 2009; 182:1194-200. [PMID: 19625060 DOI: 10.1016/j.juro.2009.05.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Indexed: 11/19/2022]
Abstract
PURPOSE Ureteral stents commonly become infected or encrusted. Various coatings have been developed to decrease bacterial adherence. To our knowledge there has been no in vitro testing of coating with heparin to date. We determined the effects of heparin coating on bacterial adherence of common uropathogens and physical stent properties. MATERIALS AND METHODS Heparin coated Radiance ureteral stents (Cook) and noncoated Endo-Sof control stents were tested against triclosan eluting Triumph(R) stents and noneluting Polaris control stents for adherence of Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, Staphylococcus aureus and Pseudomonas aeruginosa for 7 days. Adherent bacteria were determined and biofilms were visualized using fluorescent dyes. Radial, tensile and coil strength of the Radiance and Polaris stents was compared to determine the effect of heparin coating on physical stent characteristics. RESULTS Heparin coating did not decrease bacterial adhesion compared to its control. E. coli adhesion was limited by all stents tested. The Polaris stent showed significantly greater resistance to bacterial adherence for Klebsiella, Pseudomonas and Enterococcus than the Endo-Sof and Radiance stents but was more susceptible to S. aureus adherence. The Triumph stent resisted all bacteria except Pseudomonas and Enterococcus. Mature biofilms were observed on all stents with lower viability on the Triumph stent. Radiance stents showed higher tensile and lower compression strength than its control. CONCLUSIONS Heparin coating does not decrease bacterial adherence to ureteral stents. Drug eluting antimicrobials have an inhibitory effect on bacterial adherence and the Polaris stent showed the least bacterial adherence of the nondrug eluting ureteral stents tested.
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Affiliation(s)
- Dirk Lange
- Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
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22
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Klis R, Korczak-Kozakiewicz E, Denys A, Sosnowski M, Rozanski W. Relationship Between Urinary Tract Infection and Self-Retaining Double-J Catheter Colonization. J Endourol 2009; 23:1015-9. [DOI: 10.1089/end.2008.0518] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rafal Klis
- 2nd Department of Urology, Medical University of Lodz, Lodz, Poland
| | | | - Andrzej Denys
- Department of Microbiology, Medical University of Lodz, Lodz, Poland
| | - Marek Sosnowski
- 1st Department of Urology, Medical University of Lodz, Lodz, Poland
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23
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Minardi D, Montanari MP, Tili E, Cochetti I, Mingoia M, Varaldo PE, Muzzonigro G. Effects of fluoroquinolones on bacterial adhesion and on preformed biofilm of strains isolated from urinary double J stents. J Chemother 2008; 20:195-201. [PMID: 18467245 DOI: 10.1179/joc.2008.20.2.195] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The activity of levofloxacin and ulifloxacin on biofilm formation and persistence was evaluated on microorganisms isolated from urinary double-J-stents. We analyzed 51 bacterial strains and their susceptibility to different antimicrobial classes was determined. We evaluated the bacterial ability to form biofilm and the effects of different concentrations of levofloxacin and ulifloxacin on bacterial adhesion and biofilm persistence. Most of the strains were biofilm producers with no relevant difference in biofilm production at 24 or 48 hours. The fluoroquinolones were able to prevent biofilm formation, but not to eradicate the preformed biofilm. On the basis of our data we advise that antibiotic prophylaxis with fluoroquinolones may be most helpful if given at the time of stent insertion and at high dosage.
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Affiliation(s)
- D Minardi
- Institute of Microbiology and Biomedical Sciences, Polytechnic University of the Marche Region, A.O. Ospedali Riuniti, Ancona, Italy.
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24
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John T, Rajpurkar A, Smith G, Fairfax M, Triest J. Antibiotic pretreatment of hydrogel ureteral stent. J Endourol 2008; 21:1211-6. [PMID: 17949328 DOI: 10.1089/end.2007.9904] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To compare bacterial adhesion to hydrogel-coated and uncoated ureteral stents. The antimicrobial activity of coated and uncoated stents treated with commonly used antibiotic solutions also was evaluated. MATERIALS AND METHODS Hydrogel coated and uncoated stent segments were dipped in different antibiotic solutions (ciprofloxacin, gentamicin, and cefazolin). Normal saline was used as the control. The segments were incubated in separate broths of Escherichia coli and Enterococcus faecalis to reach the log phase. They were sonicated to free the bacteria, and colony-forming units were determined after 48 hours. To evaluate antibacterial activity, hydrogel-coated and uncoated stent segments were dipped in the above-mentioned antibiotic solutions. Normal saline was used as the control. Segments were incubated in separate Mueller-Hinton agar plates inoculated with E. coli or Enterococcus faecalis, and the zones of inhibition were determined at 24 hours. The duration of antibacterial activity for each bacterium-antibiotic combination also was studied. RESULTS Hydrogel coating did not significantly reduce bacterial adhesion. Zones of inhibition around stent pieces dipped in antibiotic solutions differed with the organism and the antibiotic. Cefazolin produced a significantly larger zone of inhibition with hydrogel-coated stent, but the duration of antibacterial activity was similar to that of uncoated stent. Hydrophilic coating significantly increased the duration of antibacterial activity of ciprofloxacin and gentamicin. CONCLUSION Hydrogel coating on the surface of ureteral stents does not prevent or reduce bacterial adhesion. However, after antibiotic treatment, stents exhibit antibacterial activity in the local environment at greater intensity and for a longer time, depending on the bacterium-antibiotic combination.
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Affiliation(s)
- Tony John
- Department of Urology, Wayne State University, Detroit, Michigan 48201, USA.
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25
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Koseoglu H, Aslan G, Esen N, Sen BH, Coban H. Ultrastructural stages of biofilm development of Escherichia coli on urethral catheters and effects of antibiotics on biofilm formation. Urology 2006; 68:942-6. [PMID: 17113884 DOI: 10.1016/j.urology.2006.06.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Revised: 05/02/2006] [Accepted: 06/05/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Biofilm formation on biomaterials by various kinds of bacteria renders the infection chronic, and the bacteria can become resistant to the immune system and antibiotics. Developmental biofilm stages of Escherichia coli on urethral catheters have not yet been thoroughly demonstrated. We aimed to show biofilm formation of E. coli on urethral catheters, and the effects of various antibacterial agents on this formation using scanning electron microscopy. METHODS Using urine infected with uropathogenic E. coli type O4 (10(5) to 10(6) colony forming units/mL), biofilm was formed on latex/silicone balloon catheters in a modified Robbin's device. The study included an infected-only group and four antibiotic study groups (ciprofloxacin, cefuroxime, gentamicin, and trimethoprim). The catheters were infused with the antibiotic solutions once before placement in the modified Robbin's devices. Ten 5-mm catheter samples were taken for all groups on the first, fourth, and seventh days. The 4 and 12-hour and 2-day samplings were also taken from the infected-only group. The catheter samples were evaluated by scanning electron microscopy and given scores according to the level of formation. RESULTS The biofilm layers emerged between 4 and 12 hours after infection in the infected-only group and had developed completely between 12 and 24 hours. The antibiotics, especially cefuroxime, significantly delayed this process for up to 4 days. However, the biofilm had developed completely in almost all catheter samples after 4 to 7 days. CONCLUSIONS Biofilm of E. coli on urethral catheters had completed their maturation at 12 to 24 hours. For short-term urethral catheterization, a single dose of antibiotic can delay the development of biofilm for up to 4 days but eventually cannot prevent it.
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Affiliation(s)
- Hikmet Koseoglu
- Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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26
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Tenke P, Kovacs B, Benkõ R, Ashaber D, Nagy E. Continuous versus intermittent levofloxacin treatment in complicated urinary tract infections caused by urinary obstruction temporarily relieved by foreign body insertion. Int J Antimicrob Agents 2006; 28 Suppl 1:S82-5. [PMID: 16857348 DOI: 10.1016/j.ijantimicag.2006.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study was one of the first to examine the in vivo levofloxacin adsorption to stent surfaces. The results demonstrated the ability of this antibiotic to adsorb to the conditioning film and to the surface of the inserted device, and showed that 1-2 weeks after the discontinuation of antibiotic administration some amount of the antibiotic still could be detected on them. The second aim of the investigation was to determine whether continuous or intermittent levofloxacin treatment is advantageous for the patients who have acute complicated urinary tract infection (UTI) caused by urinary obstruction. The results did not show any clinical or microbiological advantages of the continuous therapy.
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Affiliation(s)
- Peter Tenke
- Jahn Ferenc South-Pest Hospital Urology Department, Budapest, Hungary.
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27
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Chew BH, Denstedt JD. Technology insight: Novel ureteral stent materials and designs. ACTA ACUST UNITED AC 2006; 1:44-8. [PMID: 16474466 DOI: 10.1038/ncpuro0014] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2004] [Accepted: 09/18/2004] [Indexed: 11/09/2022]
Abstract
Ureteral stents are an important tool for aiding upper urinary tract drainage, but can cause significant patient morbidity. Common problems include stent-induced pain, hematuria, dysuria, infection, and encrustation. From a urologist's perspective, stents must be easy to maneuver in the urinary tract, radiopaque, and affordable. Since the development of the modern day stent in 1978, stents have evolved to include softer biomaterials that are more resistant to encrustation and infection. An ideal biomaterial is one that is not affected by its environment and does not elicit reactive changes in surrounding tissues. To date, the ideal biomaterial or stent does not exist. This review discusses developments that address the issues of infection, biofilm formation, encrustation, and patient comfort. Stent materials including polyurethane, silicone, biodegradable substances and new combination polymers are reviewed, in addition to novel stent coatings such as heparin, hydrogel, and silver nitrate. Ureteral stent technologies currently lag behind vascular stents, particularly drug-eluting stents, but new developments will continue to improve these essential urological tools.
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Affiliation(s)
- Ben H Chew
- University of Western Ontario, London, Ontario, Canada
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28
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Tenke P, Kovacs B, Jäckel M, Nagy E. The role of biofilm infection in urology. World J Urol 2006; 24:13-20. [PMID: 16402262 DOI: 10.1007/s00345-005-0050-2] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Accepted: 12/06/2005] [Indexed: 11/28/2022] Open
Abstract
In the process of endourological development a great variety of foreign bodies have been invented besides urinary catheters on which biofilm can be formed. Bacteria in the biofilm are less sensible to antibiotics. An additional problem of medical biomaterials in the urinary tract environment is the development of encrustation and consecutive obstruction. In this review, we tried to sum up the conditions where biofilm formation has a great impact on the development or maintenance of urological infections and on treatment success. Modification of the biomaterial surface seems to be the most promising prevention strategy for bacterial biofilms. Easier methods for diagnosing and quantifying biofilm infection, to develop more specific antimicrobial agents and ideal device surfaces would surely help the fight against biofilm formation.
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Affiliation(s)
- P Tenke
- Department of Urology, Jahn Ferenc South-Pest Hospital, Köves utca 2-4, 1204 Budapest, Hungary.
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29
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Shaw GL, Choong SK, Fry C. Encrustation of biomaterials in the urinary tract. ACTA ACUST UNITED AC 2004; 33:17-22. [PMID: 15614579 DOI: 10.1007/s00240-004-0423-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2004] [Accepted: 03/22/2004] [Indexed: 10/26/2022]
Abstract
This review considers the problem of the encrustation of biomaterials used for urinary prostheses. After a general discussion of the problem it deals with exciting new developments which may prove to be clinically applicable in preventing this costly and resource consuming complication. The widespread use of use of in vitro models which accurately simulate the conditions found in the human urinary tract will allow appropriate preliminary studies. Perhaps then clinical evaluation will be warranted.
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Affiliation(s)
- Greg L Shaw
- The Institute of Urology and Nephrology, University College London, London, UK.
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30
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Bret L, Di Martino P. Effect of ceftazidime, amikacin and ciprofloxacin on biofilm formation by some enterobacterial clinical isolates. Chemotherapy 2004; 50:255-9. [PMID: 15528892 DOI: 10.1159/000081947] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2003] [Accepted: 03/23/2004] [Indexed: 11/19/2022]
Abstract
The effect of sub-minimal inhibitory concentrations of antimicrobial agents on the biofilm formationto polystyrene by Escherichia coli, Proteus vulgaris, Providencia stuartii, and Morganella morganii was investigated by examining eight clinical strains. All the isolates tested were efficient biofilm-forming strains in the microtiter plate assay, with crystal violet staining (OD595 nm) ranging from 0.13 +/- 0.01 for P. stuartii ER21870 to 1.23 +/- 0.02 for P. vulgaris ER50120. The biofilm formation of the majority of the strains was affected in the presence of ceftazidime or ciprofloxacin: biofilm formation significantly decreased for all the E. coli and P. vulgaris strains in the presence of either of the two antibiotics, it also decreased for M. morganii ER89472 in the presence of ceftazidime but increased for P. stuartii ER21870 and M. morganii ER89472 in the presence of ciprofloxacin. Amikacin decreased only the biofilm formation of P. stuartii ER08274. In addition to their antibacterial activity, ceftazidime and ciprofloxacin could be effective in preventing the biofilm formation of E. coli and P. vulgaris.
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Affiliation(s)
- Laurent Bret
- Laboratoire de Microbiologie, Centre hospitalier régional d'Orléans, France
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31
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32
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Tenke P, Riedl CR, Jones GL, Williams GJ, Stickler D, Nagy E. Bacterial biofilm formation on urologic devices and heparin coating as preventive strategy. Int J Antimicrob Agents 2004; 23 Suppl 1:S67-74. [PMID: 15037330 DOI: 10.1016/j.ijantimicag.2003.12.007] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the process of endourological development a variety of foreign bodies have been invented besides urinary catheters, on which biofilm can be formed. Bacteria in the biofilm are less susceptible to antibiotics. An additional problem of medical biomaterials in the urinary tract environment is the development of encrustation and consecutive obstruction. The most promising prevention strategy for bacterial biofilms is the production of materials with anti-adhesive surfaces such as heparin. Although heparin-coated ureteral stents are expensive, they justify their cost. Our studies show that such devices are protected against incrustation and biofilm formation for a longer period of time: 6-12 months, both in vitro and in vivo.
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Affiliation(s)
- Peter Tenke
- Department of Urology, Jahn Ferenc South-Pest Hospital, H-1204 Budapest, Köves u. 2-4, Hungary.
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Abstract
PURPOSE OF REVIEW Ureteral stents are a mainstay of today's urological armamentarium. This review critically evaluates the recent literature and provides a concise summary of the use of stents in urology today. While stents are used in many reconstructive urologic procedures, this review focuses on the use of stents in urolithiasis as it pertains to ureteroscopy, shockwave lithotripsy, and ureteropelvic junction obstruction. RECENT FINDINGS Ureteral stents are associated with irritative symptoms, hematuria, infection, and encrustation. A new validated quality of life and impact questionnaire has been developed and has shown that 76% of patients suffer at least some type of morbidity related to the stent. Many studies in the recent literature have re-examined our use of stents today. For example, concepts regarding stenting following ureteroscopy, before shockwave lithotripsy, and following endopyelotomy have undergone an evolution based on the results of randomized, prospective studies. SUMMARY The ureteral stent is an invaluable urological tool and its indications are evolving as are new stent technologies to improve patient care and comfort.
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Affiliation(s)
- Ben H Chew
- Department of Urology, University of Western Ontario, St Joseph's Health Care, 268 Grosvenor Street, London, Ontario, Canada N6A 4V2
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34
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Abstract
As the quality of ureteroscopy continues to improve, ancillary instrumentation will advance. The endourologist now has a vast supply of specially designed guidewires, stents, balloons, and baskets. These technologies have expanded the realm of cases that may be managed endoscopically. As the urologist becomes more familiar with the options at his or her disposal, patient care will improve.
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Affiliation(s)
- Bradley H Rosenberg
- Department of Urology, Wayne State University School of Medicine, 4160 John R, Suite 1017, Detroit, MI 48201, USA
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