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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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2
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Svane S, Lyngsie MC, Klitgaard JK, Karring H. Synergistic inhibition of ureolytic activity and growth of Klebsiella pneumoniae in vitro suggests cobinding of fluoride and acetohydroxamic acid at the urease active site and provides a novel strategy to combat ureolytic bacteria. Heliyon 2024; 10:e31209. [PMID: 38826744 PMCID: PMC11141357 DOI: 10.1016/j.heliyon.2024.e31209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/18/2024] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
The ability of ureolytic bacteria to break down stable urea to alkaline ammonia leads to several environmental and health challenges. Ureolytic bacteria such as Helicobacter pylori, Klebsiella pneumoniae, and Proteus mirabilis can become pathogenic and cause persistent infections that can be difficult to treat. Inhibiting urease activity can reduce the growth and pathogenicity of ureolytic bacteria. In the present in vitro study, we investigated the synergistic effects of tannic acid (TA) and the urease inhibitors fluoride (F-) and acetohydroxamic acid (AHA). The concentration of AHA needed for efficient inhibition of the ureolytic activity of K. pneumoniae can be significantly reduced if AHA is coapplied with tannic acid and sodium fluoride (NaF). Thus, only 1.20 μmol l-1 AHA in combination with 0.30 mmol l-1 tannic acid and 0.60 mmol l-1 NaF delayed the onset of ureolytic pH increase by 95.8 % and increased the growth lag phase by 124.3 % relative to untreated K. pneumoniae. At these concentrations, without AHA, TA and NaF increased the onset of the ureolytic pH change by only 37.0 % and the growth lag phase by 52.5 %. The strong inhibition obtained with low concentrations of AHA in triple-compound treatments suggests cobinding of F- and AHA at the urease active site and could reduce the side effects of AHA when it is employed as a drug against e.g. urinary tract infections (UTIs) and blocked catheters. This study reports the basis for a promising novel therapeutic strategy to combat infections caused by ureolytic bacteria and the formation of urinary tract stones and crystalline biofilms on catheters.
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Affiliation(s)
- Simon Svane
- Department of Green Technology, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Mie C. Lyngsie
- Department of Biochemistry and Molecular Biology, Research Unit of Molecular Microbiology, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Janne K. Klitgaard
- Department of Biochemistry and Molecular Biology, Research Unit of Molecular Microbiology, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
- Institute of Clinical Research, Research Unit of Clinical Microbiology, University of Southern Denmark, J. B. Winsløws Vej 21, 2. sal, 5000, Odense C, Denmark
| | - Henrik Karring
- Department of Green Technology, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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3
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Fitzgerald MJ, Pearson MM, Mobley HLT. Proteus mirabilis UreR coordinates cellular functions required for urease activity. J Bacteriol 2024; 206:e0003124. [PMID: 38534115 PMCID: PMC11025324 DOI: 10.1128/jb.00031-24] [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: 01/30/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024] Open
Abstract
A hallmark of Proteus mirabilis infection of the urinary tract is the formation of stones. The ability to induce urinary stone formation requires urease, a nickel metalloenzyme that hydrolyzes urea. This reaction produces ammonia as a byproduct, which can serve as a nitrogen source and weak base that raises the local pH. The resulting alkalinity induces the precipitation of ions to form stones. Transcriptional regulator UreR activates expression of urease genes in a urea-dependent manner. Thus, urease genes are highly expressed in the urinary tract where urea is abundant. Production of mature urease also requires the import of nickel into the cytoplasm and its incorporation into the urease apoenzyme. Urease accessory proteins primarily acquire nickel from one of two nickel transporters and facilitate incorporation of nickel to form mature urease. In this study, we performed a comprehensive RNA-seq to define the P. mirabilis urea-induced transcriptome as well as the UreR regulon. We identified UreR as the first defined regulator of nickel transport in P. mirabilis. We also offer evidence for the direct regulation of the Ynt nickel transporter by UreR. Using bioinformatics, we identified UreR-regulated urease loci in 15 Morganellaceae family species across three genera. Additionally, we located two mobilized UreR-regulated urease loci that also encode the ynt transporter, implying that UreR regulation of nickel transport is a conserved regulatory relationship. Our study demonstrates that UreR specifically regulates genes required to produce mature urease, an essential virulence factor for P. mirabilis uropathogenesis. IMPORTANCE Catheter-associated urinary tract infections (CAUTIs) account for over 40% of acute nosocomial infections in the USA and generate $340 million in healthcare costs annually. A major causative agent of CAUTIs is Proteus mirabilis, an understudied Gram-negative pathogen noted for its ability to form urinary stones via the activity of urease. Urease mutants cannot induce stones and are attenuated in a murine UTI model, indicating this enzyme is essential to P. mirabilis pathogenesis. Transcriptional regulation of urease genes by UreR is well established; here, we expand the UreR regulon to include regulation of nickel import, a function required to produce mature urease. Furthermore, we reflect on the role of urea catalysis in P. mirabilis metabolism and provide evidence for its importance.
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Affiliation(s)
- Madison J. Fitzgerald
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Melanie M. Pearson
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Harry L. T. Mobley
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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4
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Kelly LC, Glinsky JV, Harvey LA. A case report of three people experiencing intractable autonomic dysreflexia following instillation of Uro-Tainer ® Polyhexanide 0.02. Spinal Cord Ser Cases 2024; 10:17. [PMID: 38580624 PMCID: PMC10997763 DOI: 10.1038/s41394-024-00626-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Historically, bladder washouts were used to instil therapeutic reagents directly into the bladder. This practice has expanded to include instillation of solutions that deal with catheter issues such as encrustation or formation of bio-film. They appear to provide a promising strategy for people with long term catheters. These products are readily available to purchase, but there is concern that people are using these solutions without a complete understanding of the purpose for the rinse and without clinical guidance to monitor response to treatment. CASE PRESENTATION These case studies include three people living with spinal cord injury (SCI) who developed severe autonomic dysreflexia (AD) when a catheter rinse was carried out using a particular solution. Each of the cases developed immediate and, in some cases, intractable AD requiring further intervention to resolve symptoms. DISCUSSION Catheter-associated urinary tract infection is a significant cause of morbidity and mortality in people living with SCI. Long-term catheters provide a vector for opportunistic micro-organisms to form bio-film and create an environment that promotes formation of struvite calculi, thus increasing the risk of chronic catheter blockage and urinary tract infection. Whilst these solutions are used to reduce these risks, they also pose additional risks to people susceptible to AD. These cases highlight the need for judicious patient selection and clinical oversight and management of adverse events when using catheter rinse solutions in certain people living with SCI. This is supported by a decision-making algorithm and a response to AD algorithm. This case report was prepared following the CARE Guidelines (supplementary file 1).
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Affiliation(s)
- Louise C Kelly
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
- Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia.
- Northern Sydney Local Health District, Sydney, NSW, Australia.
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5
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Córdova-Espinoza MG, González-Vázquez R, Barron-Fattel RR, Gónzalez-Vázquez R, Vargas-Hernández MA, Albores-Méndez EM, Esquivel-Campos AL, Mendoza-Pérez F, Mayorga-Reyes L, Gutiérrez-Nava MA, Medina-Quero K, Escamilla-Gutiérrez A. Aptamers: A Cutting-Edge Approach for Gram-Negative Bacterial Pathogen Identification. Int J Mol Sci 2024; 25:1257. [PMID: 38279257 PMCID: PMC10817072 DOI: 10.3390/ijms25021257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024] Open
Abstract
Early and accurate diagnoses of pathogenic microorganisms is essential to correctly identify diseases, treating infections, and tracking disease outbreaks associated with microbial infections, to develop precautionary measures that allow a fast and effective response in epidemics and pandemics, thus improving public health. Aptamers are a class of synthetic nucleic acid molecules with the potential to be used for medical purposes, since they can be directed towards any target molecule. Currently, the use of aptamers has increased because they are a useful tool in the detection of specific targets. We present a brief review of the use of aptamers to detect and identify bacteria or even some toxins with clinical importance. This work describes the advances in the technology of aptamers, with the purpose of providing knowledge to develop new aptamers for diagnoses and treatment of different diseases caused by infectious microorganisms.
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Affiliation(s)
- María Guadalupe Córdova-Espinoza
- Immunology Laboratory, Escuela Militar de Graduados de Sanidad, SEDENA, Mexico City 11200, Mexico;
- National School of Biological Sciences, National Polytechnic Institute, Laboratory of Medical Bacteriology, Mexico City 11350, Mexico; (R.G.-V.); (R.R.B.-F.)
- Mexican Social Security Institute, Unidad Medica de Alta Especialidad, Hospital de Especialidades, “Dr. Antonio Fraga Mouret”, National Medical Center La Raza, Mexico City 02990, Mexico
| | - Rosa González-Vázquez
- National School of Biological Sciences, National Polytechnic Institute, Laboratory of Medical Bacteriology, Mexico City 11350, Mexico; (R.G.-V.); (R.R.B.-F.)
- Mexican Social Security Institute, Unidad Medica de Alta Especialidad, Hospital de Especialidades, “Dr. Antonio Fraga Mouret”, National Medical Center La Raza, Mexico City 02990, Mexico
| | - Rolando Rafik Barron-Fattel
- National School of Biological Sciences, National Polytechnic Institute, Laboratory of Medical Bacteriology, Mexico City 11350, Mexico; (R.G.-V.); (R.R.B.-F.)
| | - Raquel Gónzalez-Vázquez
- Laboratory of Biotechnology, Department of Biological Systems, Metropolitana Campus Xochimilco, CONAHCYT—Universidad Autonoma, Calzada del Hueso 1100, Col. Villa Quietud, Alcaldia Coyoacan, Mexico City 04960, Mexico;
| | - Marco Antonio Vargas-Hernández
- Research Department, Escuela Militar de Graduados de Sanidad, SEDENA, Mexico City 11200, Mexico; (M.A.V.-H.); (E.M.A.-M.)
| | - Exsal Manuel Albores-Méndez
- Research Department, Escuela Militar de Graduados de Sanidad, SEDENA, Mexico City 11200, Mexico; (M.A.V.-H.); (E.M.A.-M.)
| | - Ana Laura Esquivel-Campos
- Laboratory of Biotechnology, Department of Biological Systems, Universidad Autonoma Metropolitana, Campus Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, Alcaldia Coyoacan, Mexico City 04960, Mexico; (A.L.E.-C.); (F.M.-P.); (L.M.-R.)
| | - Felipe Mendoza-Pérez
- Laboratory of Biotechnology, Department of Biological Systems, Universidad Autonoma Metropolitana, Campus Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, Alcaldia Coyoacan, Mexico City 04960, Mexico; (A.L.E.-C.); (F.M.-P.); (L.M.-R.)
| | - Lino Mayorga-Reyes
- Laboratory of Biotechnology, Department of Biological Systems, Universidad Autonoma Metropolitana, Campus Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, Alcaldia Coyoacan, Mexico City 04960, Mexico; (A.L.E.-C.); (F.M.-P.); (L.M.-R.)
| | - María Angélica Gutiérrez-Nava
- Laboratory of Microbial Ecology, Department of Biological Systems, Universidad Autonoma Metropolitana, Campus Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, Coyoacan, Mexico City 04960, Mexico;
| | - Karen Medina-Quero
- Immunology Laboratory, Escuela Militar de Graduados de Sanidad, SEDENA, Mexico City 11200, Mexico;
| | - Alejandro Escamilla-Gutiérrez
- National School of Biological Sciences, National Polytechnic Institute, Laboratory of Medical Bacteriology, Mexico City 11350, Mexico; (R.G.-V.); (R.R.B.-F.)
- Mexican Social Security Institute, Unidad Medica de Alta Especialidad, Microbiology Laboratory, Hospital General “Dr. Gaudencio González Garza”, National Medical Center La Raza, Mexico City 02990, Mexico
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6
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Dagnesses Fonseca JO, Teja García G, Luengo Batres P, Calvo Espino P. Iatrogenic enterovesical fistula secondary to a permanent urinary catheter. BMJ Case Rep 2023; 16:e257476. [PMID: 38056931 PMCID: PMC10711913 DOI: 10.1136/bcr-2023-257476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
An enterovesical fistula is a rare entity resulting from inflammatory, neoplastic and iatrogenic processes. It can manifest clinically as pneumaturia and recurrent urinary tract infections. Its diagnosis is supported by imaging examinations and its treatment is primarily surgical.
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Hidayatullah F, Renaldo J, Kloping YP, Rahman ZA, Salsabila S, Hakim L. Giant bladder calculi due to four years neglected cystostomy. Radiol Case Rep 2023; 18:3949-3953. [PMID: 37680655 PMCID: PMC10480460 DOI: 10.1016/j.radcr.2023.08.022] [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: 06/09/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 09/09/2023] Open
Abstract
Giant bladder calculi are rare and long-term usage of cystostomy could cause stone formation. Due to the lack of evidence on giant bladder calculi and the long-term usage of cystostomy can cause bladder calculi formation, we provide a case study of a man with a neglected cystostomy with giant bladder calculi for 4 years. A fixed mass was discovered in the suprapubic region. Ultrasound examination revealed 4.1 × 5.5 cm bladder calculi and contracted left kidney. Bipolar voiding cystourethrography portrayed stricture in pars pendular and membranacea, uneven bladder wall, and 4.5 × 4.5 cm bladder calculi. The stone was extracted, and the bladder filling test revealed a small bladder capacity. Since the patient refused urethral reconstruction and bladder augmentation, he was discharged with another cystostomy catheter. Six-month follow-up revealed no forming stones. Neglected cystostomy catheter can cause giant bladder calculi. Prompt diagnosis and treatment should be made to manage this condition to reduce the likelihood of bladder cancer.
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Affiliation(s)
- Furqan Hidayatullah
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Johan Renaldo
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Yudhistira Pradnyan Kloping
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Zakaria Aulia Rahman
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Sirin Salsabila
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Lukman Hakim
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, East Java, Indonesia
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8
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Miao J, Wu X, Fang Y, Zeng M, Huang Z, Ouyang M, Wang R. Multifunctional hydrogel coatings with high antimicrobial loading efficiency and pH-responsive properties for urinary catheter applications. J Mater Chem B 2023; 11:3373-3386. [PMID: 37000775 DOI: 10.1039/d3tb00148b] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Catheter-associated urinary tract infections are one of the most common hospital-acquired infections. Encrustation formation results from infection of urease-producing bacteria and further complicates the situation. A typical sign of the initial onset of encrustation formation is the alkalization of the urine (pH up to 9-10). However, effective antibacterial strategies with high antimicrobial loading efficiency and pH-responsiveness of antimicrobial release are still lacking. In this study, we developed a poly(sulfobetaine methacrylate)-tannic acid (polySBMA-TA) hydrogel coating, which served as a universal, efficient, and responsive carrier for antimicrobials on urinary catheters. Common antimicrobials, including poly(vinylpyrrolidone)-iodine, copper ions, and nitrofurazone were loaded into the polySBMA-TA coating in high efficiency (several fold higher than that of the polySBMA coating), via the formation of multiple non-covalent interactions between the antimicrobials and hydrogel coating. The hydrogel coatings maintained good antibacterial properties under neutral conditions. More importantly, the pH-responsive release of antibacterial agents under alkaline conditions further enhanced the antibacterial activity of the coatings, which was advantageous for killing the urease-producing bacteria and preventing encrustation. In vitro and in vivo tests confirmed that the hydrogel coating has good biocompatibility, and could effectively inhibit bacterial colonization and encrustation formation. This study offers new opportunities for the utilization of a simple and universal antimicrobial-loaded hydrogel coating with smart pH-responsive properties to combat bacterial colonization and encrustation formation in urinary catheters.
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Affiliation(s)
- Jiru Miao
- College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, 310014, P. R. China.
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315300, P. R. China.
| | - Xiang Wu
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315300, P. R. China.
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Li Huili Hospital, Ningbo University School of Medicine, Ningbo, 315000, China
| | - Yue Fang
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315300, P. R. China.
| | - Mingzhu Zeng
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315300, P. R. China.
| | - Zhimao Huang
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315300, P. R. China.
| | - Mi Ouyang
- College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, 310014, P. R. China.
| | - Rong Wang
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315300, P. R. China.
- University of Chinese Academy of Sciences, Beijing, 101408, P. R. China
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9
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Gonzales RR, Kumagai K, Yang Z, Yang Y, Shigemura K, Matsuyama H. Simple bio-inspired coating of ureteral stent for protein and bacterial fouling and calcium encrustation control. J Biomed Mater Res B Appl Biomater 2023. [PMID: 36941716 DOI: 10.1002/jbm.b.35250] [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: 11/29/2022] [Revised: 02/10/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
Encrustation, caused by deposition of calcium and magnesium salts present in urine, is a common problem of indwelling urinary devices, such as ureteral stent. Encrustation was also found to be related to urinary tract infections; thus, it is necessary to prepare ureteral stents with antibacterial and antifouling surfaces to mitigate the occurrence of encrustation. In this study, commercial ureteral stent was coated with polydopamine (PDA), formed from self-polymerization of dopamine. The PDA coating was optimized in terms of dopamine concentration, pH, and coating time using response surface methodology. The chosen response parameters for optimization were calcium oxalate (CaC2 O4 ) encrustation and protein adsorption. Optimized PDA coating conditions were determined to be the following: pH 9.0, 2 mg/mL DA, and 3 days coating. The optimized PDA-coated ureteral stent exhibited outstanding resistance against CaC2 O4 encrustation, protein fouling, and bacterial adhesion due to its hydrophilic and functional coating layer. In comparison with the pristine ureteral stent, PDA coating was able to suppress approximately 97% and 87% of CaC2 O4 and protein adsorption, respectively. The PDA-coated ureteral stent was compared against those of commercially available ureteral stents and found to have superior encrustation and protein fouling mitigation performance. Finally, PDA coating was found to be highly stable for a storage period of 90 days, whether stored in wet or dry conditions.
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Affiliation(s)
- Ralph Rolly Gonzales
- Research Center for Membrane and Film Technology, Kobe University, Kobe, Hyogo, Japan
| | - Kazuo Kumagai
- Research Center for Membrane and Film Technology, Kobe University, Kobe, Hyogo, Japan
- Department of Chemical Science and Engineering, Kobe University, Kobe, Hyogo, Japan
| | - Zhe Yang
- College of Civil and Transportation Engineering, Shenzhen University, Shenzhen, China
| | - Youngmin Yang
- Department of Urology, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Katsumi Shigemura
- Department of Urology, Kobe University Hospital, Kobe, Hyogo, Japan
- Department of International Health, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
| | - Hideto Matsuyama
- Research Center for Membrane and Film Technology, Kobe University, Kobe, Hyogo, Japan
- Department of Chemical Science and Engineering, Kobe University, Kobe, Hyogo, Japan
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10
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Mirzaei A, Wagemans J, Nasr Esfahani B, Lavigne R, Moghim S. A Phage Cocktail To Control Surface Colonization by Proteus mirabilis in Catheter-Associated Urinary Tract Infections. Microbiol Spectr 2022; 10:e0209222. [PMID: 36194151 PMCID: PMC9602741 DOI: 10.1128/spectrum.02092-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/02/2022] [Indexed: 12/31/2022] Open
Abstract
Proteus mirabilis is a biofilm-forming bacterium and one of the most common causes of catheter-associated urinary tract infections (CAUTIs). The rapid spread of multidrug-resistant P. mirabilis represents a severe threat to management of nosocomial infections. This study aimed to isolate a potent phage cocktail and assess its potential to control urinary tract infections caused by biofilm-forming P. mirabilis. Two lytic phages, Isf-Pm1 and Isf-Pm2, were isolated and characterized by proteome analysis, transmission electron microscopy, and whole-genome sequencing. The host range and effect of the phage cocktail to reduce the biofilm formation were assessed by a cell adhesion assay in Vero cells and a phantom bladder model. The samples treated with the phage cocktail showed a significant reduction (65%) in the biofilm mass. Anti-quorum sensing and quantitative real-time PCR assays were also used to assess the amounts of transcription of genes involved in quorum sensing and biofilm formation. Furthermore, the phage-treated samples showed a downregulation of genes involved in the biofilm formation. In conclusion, these results highlight the efficacy of two isolated phages to control the biofilms produced by P. mirabilis CAUTIs. IMPORTANCE The rapid spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacterial strains and biofilm formation of bacteria have severely restricted the use of antibiotics and become a challenging issue in hospitals. Therefore, there is a necessity for alternative or complementary treatment measures, such as the use of virulent bacteriophages (phages), as effective therapeutic strategies.
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Affiliation(s)
- Arezoo Mirzaei
- Department of Bacteriology and Virology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Bahram Nasr Esfahani
- Department of Bacteriology and Virology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rob Lavigne
- Department of Biosystems, KU Leuven, Leuven, Belgium
| | - Sharareh Moghim
- Department of Bacteriology and Virology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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11
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Ndomba ALM, Laisser RM, Konje ET, Mwanga JR, Mshana SE. Life with an Indwelling Urinary Catheter: Experiences from Male Patients Attending the Urology Clinic at a Tertiary Hospital in Northwestern Tanzania-A Qualitative Study. NURSING REPORTS 2022; 12:791-803. [PMID: 36412796 PMCID: PMC9680475 DOI: 10.3390/nursrep12040077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022] Open
Abstract
Experiences from patients living with a long-term indwelling urinary catheter (IUC) at home among men attending urology clinics have not been reported. Evidence-based information on such experiences is important for improving nursing care in low- and middle-income countries such as Tanzania. Using a descriptive phenomenological qualitative research design, we observed two main themes: "Adjustments to positive living with a catheter at home", denoting that social interaction and psychological and spiritual support are important to positively live with the catheter, and "The home environment influences negative or positive living", considering intimacy and altered body image to significantly influence the ability to practice sex, leading to wives' self-sacrifice. Respondents experienced difficulties in living with a long-term IUC at home due to a lack of information from healthcare professionals on how to manage their catheters and urine bags. In adjusting to positive or negative living with a catheter at home, respondents had to figure out strategies to minimize psychological and emotional trauma and hasten the adjustment process. A clear guideline or checklist is needed to ensure that all important information is provided by health professionals at the time of discharge and during subsequent visits to patients on how to care for the catheter insertion sites and help them adjust to living with a long-term IUC.
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Affiliation(s)
- Asteria L. M. Ndomba
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Bugando Area, Mwanza P.O. Box 1464, Tanzania
- Correspondence: ; Tel.: +255-755-435-470
| | - Rose M. Laisser
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Bugando Area, Mwanza P.O. Box 1464, Tanzania
| | - Eveline T. Konje
- Department of Biostatistics, Epidemiology and Behavioral Sciences, Catholic University of Health and Allied Sciences, Bugando Area, Mwanza P.O. Box 1464, Tanzania
| | - Joseph R. Mwanga
- School of Public Health, Catholic University of Health and Allied Sciences, Bugando Area, Mwanza P.O. Box 1464, Tanzania
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando Area, Mwanza P.O. Box 1464, Tanzania
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12
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Jordan DA. The role of the district nurse in managing blocked urinary catheters. Br J Community Nurs 2022; 27:350-356. [PMID: 35776559 DOI: 10.12968/bjcn.2022.27.7.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article will investigate the district nurse's role in managing urinary catheter blockages, looking at why people require long-term catheterisation and the causes of blockages and then reviewing treatment methods. Current practice will be critically analysed and compared to the most up to date research and literature to inform district nurses of best evidence-based practice in the hopes of improving service user outcomes and quality of life and reducing the impact this problem has upon district nursing services with regards to time and resources.
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13
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Firoozeh N, Agah E, Bauer ZA, Olusanya A, Seifi A. Catheter-Associated Urinary Tract Infection in Neurological Intensive Care Units: A Narrative Review. Neurohospitalist 2022; 12:484-497. [PMID: 35755214 PMCID: PMC9214946 DOI: 10.1177/19418744221075888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Catheter-associated urinary tract infection (CAUTI) is among the most common types of healthcare-associated infection (HAI), which is associated with poor outcomes and prolonged hospitalization in critically ill patients. Previous studies have mentioned that patients admitted to neurological ICUs are at higher risk of CAUTI compared to patients in other ICU settings. This review paper aims to review studies published during the last decade that evaluated the incidence, risk factors, causative pathogens, and preventive strategies and treatment in neuro-critically ill patients.
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Affiliation(s)
- Negar Firoozeh
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Agah
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zaith Anthony Bauer
- Department of Pulmonary Critical Care, Brooke Army Medical Center, San Antonio, TX, USA
| | - Adedeji Olusanya
- Department of Physical Medicine and Rehabilitation, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Ali Seifi
- Department of Neurosurgery, Division of Neurocritical Care, University of Texas Health, San Antonio, TX, USA
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14
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Kumar M, Shukla A, Chaudhary R, Tsomo T. SUCCESSFUL MANAGEMENT OF URINARY BLADDER CALCULUS FORMED OVER NEGLECTED FOLEY'S CATHETER WITH LASER LITHOTRIPSY: A CASE REPORT. GLOBAL JOURNAL FOR RESEARCH ANALYSIS 2022:169-171. [DOI: 10.36106/gjra/0810636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Urinary catheterisation is one of the most commonly performed urological emergency procedures
worldwide. A long dwelling urinary catheter could be complicated by catheter obstruction due to
encrustation and stone formation. Traditionally open cystolithotomy was the treatment standard but minimally invasive
procedures like cystolitholapexy , ESWL, pneumatic or Laser lithotripsy are frequently being used with greater ease and
expertise worldwide. We present the case of a 70 year old male who had urosepsis due to stone formation over the neglected
Foley's catheter balloon. The patient was managed successfully wit Holmium laser lithotripsy.
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Affiliation(s)
- Manjeet Kumar
- Mch, Assistant Professor , Deptt. Of Urology, Indira Gandhi Medical College Shimla HP, India
| | - Ankit Shukla
- DNB, Senior Resident, Deptt. Of Surgical Gastroenterology, Jawahar Lal Nehru Institute of Post Graduate Medical Education & Research Puducherry , India
| | - Rajesh Chaudhary
- MS, Assistant Professor , Deptt. Of Surgery, Pandit Jawahar Lal Nehru Government Medical College Chamba, HP, India
| | - Tenzin Tsomo
- MBBS, Pandit Jawahar Lal Nehru Government Medical College Chamba, HP, India
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15
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Mosayyebi A, Vijayakumar A, Mosayebi M, Lange D, Somani BK, Manes C, Carugo D. The accumulation of particles in ureteric stents is mediated by flow dynamics: Full-scale computational and experimental modeling of the occluded and unoccluded ureter. APL Bioeng 2022; 6:026102. [PMID: 35540726 PMCID: PMC9076127 DOI: 10.1063/5.0083260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/11/2022] [Indexed: 01/19/2023] Open
Abstract
Ureteric stents are clinically deployed to restore urinary drainage in the presence of ureteric occlusions. They consist of a hollow tube with multiple side-holes that enhance urinary drainage. The stent surface is often subject to encrustation (induced by crystals-forming bacteria such as Proteus mirabilis) or particle accumulation, which may compromise stent's drainage performance. Limited research has, however, been conducted to evaluate the relationship between flow dynamics and accumulation of crystals in stents. Here, we employed a full-scale architecture of the urinary system to computationally investigate the flow performance of a ureteric stent and experimentally determine the level of particle accumulation over the stent surface. Particular attention was given to side-holes, as they play a pivotal role in enhancing urinary drainage. Results demonstrated that there exists an inverse correlation between wall shear stress (WSS) and crystal accumulation at side-holes. Specifically, side-holes with greater WSS levels were those characterized by inter-compartmental fluid exchange between the stent and ureter. These "active" side-holes were located either nearby ureteric obstructions or at regions characterized by a physiological constriction of the ureter. Results also revealed that the majority of side-holes (>60%) suffer from low WSS levels and are, thus, prone to crystals accumulation. Moreover, side-holes located toward the proximal region of the ureter presented lower WSS levels compared to more distal ones, thus suffering from greater particle accumulation. Overall, findings corroborate the role of WSS in modulating the localization and extent of particle accumulation in ureteric stents.
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Affiliation(s)
| | - Aravinthan Vijayakumar
- Department of Mechanical Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Maryam Mosayebi
- Department of Mechanical Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Dirk Lange
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver V6H 3Y8, Canada
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, United Kingdom
| | - Costantino Manes
- Department of Environment, Land and Infrastructure Engineering, Politecnico di Torino, Turin 10129, Italy
| | - Dario Carugo
- Department of Pharmaceutics, UCL School of Pharmacy, University College London (UCL), London WC1N 1AX, United Kingdom
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16
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Huang Z, Zhang D, Gu Q, Miao J, Cen X, Golodok RP, Savich VV, Ilyushchenko AP, Zhou Z, Wang R. One-step coordination of metal-phenolic networks as antibacterial coatings with sustainable and controllable copper release for urinary catheter applications. RSC Adv 2022; 12:15685-15693. [PMID: 35685702 PMCID: PMC9132196 DOI: 10.1039/d2ra01675c] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/17/2022] [Indexed: 02/05/2023] Open
Abstract
Catheter-associated urinary tract infections (CAUTIs) draw great concern due to increased demand for urinary catheters in hospitalization. Encrustation caused by urinary pathogens, especially Proteus mirabilis, results in blocking of the catheter lumen and further infections. In this study, a facile and low-cost surface modification strategy of urinary catheters was developed using one-step coordination of tannic acid (TA) and copper ions. The copper content of the coating could be manipulated by the number of TA-Cu (TC) layers, and the coating released copper in a pH-responsive manner. The coating exhibited high antibacterial efficiency (killed >99% of planktonic bacteria, and reduced biofilm coverage to <1% after 24 h) due to the synergistic antimicrobial effect of TA and copper ions. In vivo study with a rabbit model indicated that with two TC layers, the coated catheter could effectively inhibit bacterial growth in urine and colonization on the surface, and reduce encrustation formation. In addition, the TC-coated catheter exhibited better tissue compatibility compared to the unmodified catheter, probably due to the antibacterial performance of the coating. Such a straightforward coating strategy with good in vitro and in vivo antibacterial properties and biocompatibility holds great promise for combating CAUTIs in clinical practice.
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Affiliation(s)
- Zhimao Huang
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences Ningbo 315300 China
| | - Dawei Zhang
- Department of Urology, The Southwest Hospital, Army Medical University No. 30 Gaotanyan Street, Shapingba District Chongqing 400038 China
| | - Qinwei Gu
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences Ningbo 315300 China
| | - Jiru Miao
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences Ningbo 315300 China
| | - Xiao Cen
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences Ningbo 315300 China
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University No. 14, 3rd Section, South Renmin Road Chengdu 610041 China
| | - Robert Petrovich Golodok
- SSI O V Roman Powder Metallurgy Institute, National Academy of Sciences of Belarus Minsk 220005 Belarus
| | - Vadim Victorovich Savich
- SSI O V Roman Powder Metallurgy Institute, National Academy of Sciences of Belarus Minsk 220005 Belarus
| | | | - Zhansong Zhou
- Department of Urology, The Southwest Hospital, Army Medical University No. 30 Gaotanyan Street, Shapingba District Chongqing 400038 China
| | - Rong Wang
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences Ningbo 315300 China
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17
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Duran Ramirez JM, Gomez J, Obernuefemann CLP, Gualberto NC, Walker JN. Semi-Quantitative Assay to Measure Urease Activity by Urinary Catheter-Associated Uropathogens. Front Cell Infect Microbiol 2022; 12:859093. [PMID: 35392611 PMCID: PMC8980526 DOI: 10.3389/fcimb.2022.859093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Catheter-associated urinary tract infections (CAUTIs) are one of the most common healthcare-associated infections in the US, accounting for over 1 million cases annually and totaling 450 million USD. CAUTIs have high morbidity and mortality rates and can be caused by a wide range of pathogens, making empiric treatment difficult. Furthermore, when urease-producing uropathogens cause symptomatic CAUTI or asymptomatic catheter colonization, the risk of catheter failure due to blockage increases. The enzyme urease promotes catheter blockage by hydrolyzing urea in urine into ammonia and carbon dioxide, which results in the formation of crystals that coat the catheter surface. If CAUTI is left untreated, the crystals can grow until they block the urinary catheter. Catheter blockage and subsequent failure reduces the quality of life for the chronically catheterized, as it requires frequent catheter exchanges and can promote more severe disease, including dissemination of the infection to the kidneys or bloodstream. Thus, understanding how urease contributes to catheter blockages and/or more severe disease among the broad range of urease-producing microbes may provide insights into better prevention or treatment strategies. However, clinical assays that detect urease production among clinical isolates are qualitative and prioritize the detection of urease from Proteus mirabilis, the most well-studied uropathogenic urease producer. While urease from other known urease producers, such as Morganella morganii, can also be detected with these methods, other uropathogens, including Staphylococcus aureus and Klebsiella pneumonia, are harder to detect. In this study, we developed a high throughput, semiquantitative assay capable of testing multiple uropathogens in a rapid and efficient way. We validated the assay using Jack Bean urease, the urease producing species: Proteus spp., M. morganii, K. pneumonia, and S. aureus strains, and the non-urease producer: Escherichia coli. This modified assay more rapidly detected urease-producing strains compared to the current clinical test, Christensen Urea Agar, and provided semiquantitative values that may be used to further investigate different aspects of urease regulation, production, or activity in these diverse species. Furthermore, this assay can be easily adapted to account for different environmental stimuli affecting urease production, including bacterial concentration, aeration, or addition of anti-urease compounds.
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Affiliation(s)
- Jesus M. Duran Ramirez
- Department of Microbiology and Molecular Genetics, McGovern Medical School, The University of Texas Health Science Center, Houston, TX, United States
- Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, School of Public Health, The University of Texas Health Science Center, Houston, TX, United States
| | - Jana Gomez
- Department of Microbiology and Molecular Genetics, McGovern Medical School, The University of Texas Health Science Center, Houston, TX, United States
| | - Chloe L. P. Obernuefemann
- The Center for Women’s Infectious Disease Research, Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Nathaniel C. Gualberto
- The Center for Women’s Infectious Disease Research, Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jennifer N. Walker
- Department of Microbiology and Molecular Genetics, McGovern Medical School, The University of Texas Health Science Center, Houston, TX, United States
- Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, School of Public Health, The University of Texas Health Science Center, Houston, TX, United States
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18
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Ndomba ALM, Laisser RM, Silago V, Kidenya BR, Mwanga J, Seni J, Mshana SE. Urinary Tract Infections and Associated Factors among Patients with Indwelling Urinary Catheters Attending Bugando Medical Centre a Tertiary Hospital in Northwestern Tanzania. Microorganisms 2022; 10:microorganisms10020473. [PMID: 35208927 PMCID: PMC8879566 DOI: 10.3390/microorganisms10020473] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/10/2022] Open
Abstract
Complications of indwelling urinary catheterization (IUC) are associated with significant morbidity and mortality, thus affecting patient's well-being. Understanding the magnitude and factors associated with complications is crucial in designing appropriate preventive strategies. A cross-sectional study was conducted at Bugando Medical Centre, involving patients with long-term and short-term IUC from December 2016 to September 2017. The data were analyzed by STATA 13.0. Catheter-associated urinary tract infection (CA-UTI) was the leading (56.8%; 250/440) complication among patients with IUC. Gram-negative bacteria were predominantly isolated (98.1%, 252/257), whereas E. coli (30.7%, 79/257) and Klebsiella spp. (29.6%, 76/257) were the leading pathogens. CA-UTI was significantly higher among out-patients than in-patients (82.2% v 35.3%, p < 0.001). Older age (OR: 1.3, (95%CI: 1.1-1.5), p < 0.001), level of education (OR: 1.8, (95%CI: 1.1-3.1), p = 0.029) and catheter duration of ≥6 weeks (OR: 2.43, (95%CI: 1.1-5.5), p = 0.031) independently predicted CA-UTI among outpatients, while female gender (OR: 2.1, (95%CI: 1.2-3.7), p = 0.014), catheter bags not freely hanging (OR: 0.4, (95%CI: 0.2-0.7), p = 0.002) and residing outside Mwanza region (OR: 0.4, (95%CI: 0.2-0.6), p < 0.001) predicted CA-UTI among in-patients. CA-UTI is the common complication among patients with IUC, significantly higher in out-patients than in-patients. We recommend involving patients and carers in infection prevention and control measures in out-patients living with IUC.
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Affiliation(s)
- Asteria L. M. Ndomba
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
- Correspondence:
| | - Rose M. Laisser
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (J.S.); (S.E.M.)
| | - Benson R. Kidenya
- Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Joseph Mwanga
- Department of Biostatistics, Epidemiology and Behavioral Sciences, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (J.S.); (S.E.M.)
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (J.S.); (S.E.M.)
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19
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Douglass M, Ghalei S, Brisbois E, Handa H. Potent, Broad-Spectrum Antimicrobial Effects of S-Nitroso- N-acetylpenicillamine-Impregnated Nitric Oxide-Releasing Latex Urinary Catheters. ACS APPLIED BIO MATERIALS 2022; 5:700-710. [PMID: 35119808 PMCID: PMC9680922 DOI: 10.1021/acsabm.1c01130] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Although numerous prevention and intervention techniques have been developed to counteract catheter-associated urinary tract infections (CAUTIs), urinary catheters remain one of the most common sources of hospital-acquired infections. Nitric oxide (NO), a gaseous free radical responsible for regulating many physiological functions in the body, has gained immense popularity due to its potent, broad-spectrum antimicrobial activity, which is capable of combating medical device-associated infections. In this work, a straightforward solvent-swelling method was used to load the NO donor S-nitroso-N-acetyl-penicillamine (SNAP) into commercial latex catheters (SNAP-UCs) for the first time. The effects of swelling catheters with different concentrations of SNAP solutions (25-125 mg/mL SNAP in tetrahydrofuran (THF)) were studied by measuring the NO release kinetics, SNAP loading, and SNAP leaching. SNAP-UCs impregnated with a 50 mg/mL SNAP-THF solution were found to maximize the amount of SNAP loaded into the latex (0.115 ± 0.009 mg SNAP/mg catheter) and showed physiological levels of NO release (>2 × 10-10 mol min-1 cm-2) over 7 days and minimal SNAP leaching (<2%). SNAP-UCs showed impressive in vitro contact-based and diffusible antimicrobial efficacy against three CAUTI-associated pathogens, reducing the viability of adhered and planktonic Escherichia coli, Proteus mirabilis, and Staphylococcus aureus by ∼98.0 to 99.1% (adhered) and 86.3-96.3% (planktonic) compared to control latex catheters. In vitro cytotoxicity against 3T3 mouse fibroblasts using a CCK-8 assay showed that SNAP-UCs were noncytotoxic (>90% viability). In summary, SNAP-UCs show stable, noncytotoxic NO release characteristics capable of potent, broad-spectrum antimicrobial activity, demonstrating great potential for reducing the devastating effects associated with CAUTIs.
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Affiliation(s)
- Megan Douglass
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Sama Ghalei
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Elizabeth Brisbois
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Hitesh Handa
- School of Chemical, Materials and Biomedical Engineering, College of Engineering and Pharmaceutical and Biomedical Sciences Department, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
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20
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Optimisation of a lozenge-based sensor for detecting impending blockage of urinary catheters. Biosens Bioelectron 2022; 197:113775. [PMID: 34781179 DOI: 10.1016/j.bios.2021.113775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/20/2022]
Abstract
Catheter-associated urinary tract infections resulting from urease-positive microorganisms are more likely to cause a urinary catheter blockage owing to the urease activity of the microbes. Catheter blockage can be dangerous and increases the risk of severe infections, such as sepsis. Ureases, a virulence factor in Proteus mirabilis, cause an increase in urine pH - leading to blockage. An optimised biosensor "lozenge" is presented here, which is able to detect impending catheter blockage. This lozenge has been optimised to allow easy manufacture and commercialisation. It functions as a sensor in a physiologically representative model of a catheterised urinary tract, providing 6.7 h warning prior to catheter blockage. The lozenge is stable in healthy human urine and can be sterilized for clinical use by ethylene oxide. Clinically, the lozenge will provide a visible indication of impending catheter blockage, enabling quicker clinical intervention and thus reducing the morbidity and mortality associated with blockage.
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21
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Sharma S, Basu B. Biomaterials assisted reconstructive urology: The pursuit of an implantable bioengineered neo-urinary bladder. Biomaterials 2021; 281:121331. [PMID: 35016066 DOI: 10.1016/j.biomaterials.2021.121331] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/14/2021] [Accepted: 12/24/2021] [Indexed: 12/27/2022]
Abstract
Urinary bladder is a dynamic organ performing complex physiological activities. Together with ureters and urethra, it forms the lower urinary tract that facilitates urine collection, low-pressure storage, and volitional voiding. However, pathological disorders are often liable to cause irreversible damage and compromise the normal functionality of the bladder, necessitating surgical intervention for a reconstructive procedure. Non-urinary autologous grafts, primarily derived from gastrointestinal tract, have long been the gold standard in clinics to augment or to replace the diseased bladder tissue. Unfortunately, such treatment strategy is commonly associated with several clinical complications. In absence of an optimal autologous therapy, a biomaterial based bioengineered platform is an attractive prospect revolutionizing the modern urology. Predictably, extensive investigative research has been carried out in pursuit of better urological biomaterials, that overcome the limitations of conventional gastrointestinal graft. Against the above backdrop, this review aims to provide a comprehensive and one-stop update on different biomaterial-based strategies that have been proposed and explored over the past 60 years to restore the dynamic function of the otherwise dysfunctional bladder tissue. Broadly, two unique perspectives of bladder tissue engineering and total alloplastic bladder replacement are critically discussed in terms of their status and progress. While the former is pivoted on scaffold mediated regenerative medicine; in contrast, the latter is directed towards the development of a biostable bladder prosthesis. Together, these routes share a common aspiration of designing and creating a functional equivalent of the bladder wall, albeit, using fundamentally different aspects of biocompatibility and clinical needs. Therefore, an attempt has been made to systematically analyze and summarize the evolution of various classes as well as generations of polymeric biomaterials in urology. Considerable emphasis has been laid on explaining the bioengineering methodologies, pre-clinical and clinical outcomes. Some of the unaddressed challenges, including vascularization, innervation, hollow 3D prototype fabrication and urinary encrustation, have been highlighted that currently delay the successful commercial translation. More importantly, the rapidly evolving and expanding concepts of bioelectronic medicine are discussed to inspire future research efforts towards the further advancement of the field. At the closure, crucial insights are provided to forge the biomaterial assisted reconstruction as a long-term therapeutic strategy in urological practice for patients' care.
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Affiliation(s)
- Swati Sharma
- Laboratory for Biomaterials, Materials Research Centre, Indian Institute of Science, Bangalore, 560012, India
| | - Bikramjit Basu
- Laboratory for Biomaterials, Materials Research Centre, Indian Institute of Science, Bangalore, 560012, India; Centre for Biosystems Science and Engineering, Indian Institute of Science, Bangalore, 560012, India.
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22
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Iribarnegaray V, González MJ, Caetano AL, Platero R, Zunino P, Scavone P. Relevance of iron metabolic genes in biofilm and infection in uropathogenic Proteus mirabilis. CURRENT RESEARCH IN MICROBIAL SCIENCES 2021; 2:100060. [PMID: 34841350 PMCID: PMC8610330 DOI: 10.1016/j.crmicr.2021.100060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/19/2021] [Accepted: 08/15/2021] [Indexed: 11/16/2022] Open
Abstract
The microorganisms are found in the environment, forming sessile communities embedded in an extracellular matrix of their own production, called biofilm. These communities have a great relevance in the clinical context, since they are associated with infections caused by biofilm in medical implants, such as urinary catheters. The development of biofilms is a complex process where a great diversity of genes participate. The present work is based on the study of genes related to iron metabolism and its implication in the development of P. mirabilis biofilms and pathogenicity. For this study, two mutant strains defective in biofilm formation were selected, generated by the interruption of genes that encoded non-heme ferritin and TonB-dependent receptor. The mutations influence on the development of the biofilm was evaluated by different approaches. The complexity of the biofilm was analyzed using Confocal Laser Microscopy and image analysis. The mutants infectivity potential was assessed in two experimental mice models of urinary tract infection. The results obtained in the present work show us the role of the ferritin and a TonB-associated porin protein over the initial and later stages of biofilm development. Moreover, in the ascending UTI mouse model, both mutants failed to colonize the urinary tract. In CAUTI models, ferritin mutant damaged the bladder similarly to wild type but the Ton-B mutant was unable to generate infection in the urinary tract. The results obtained in the present work confirm the relevant role that iron metabolism genes have in P. mirabilis biofilm development and for infection in the urinary tract.
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Affiliation(s)
- V Iribarnegaray
- Department of Microbiology, Instituto de Investigaciones Biológicas Clemente Estable, Avda. Italia 3318, Montevideo CP 11600, Uruguay
- Department of Pathobiology, Facultad de Veterinaria, Universidad de la República, Alberto Lasplaces 1620, Montevideo, Uruguay
| | - MJ González
- Laboratory of Microbial Biofilms, Department of Microbiology, Instituto de Investigaciones Biológicas Clemente Estable, Avda. Italia 3318, Montevideo CP 11600, Uruguay
| | - AL Caetano
- Department of Microbiology, Instituto de Investigaciones Biológicas Clemente Estable, Avda. Italia 3318, Montevideo CP 11600, Uruguay
| | - R Platero
- Department of Biochemistry and Microbial Genomics, Instituto de Investigaciones Biológicas Clemente Estable, Avda. Italia 3318, Montevideo CP 11600, Uruguay
| | - P Zunino
- Department of Microbiology, Instituto de Investigaciones Biológicas Clemente Estable, Avda. Italia 3318, Montevideo CP 11600, Uruguay
| | - P Scavone
- Laboratory of Microbial Biofilms, Department of Microbiology, Instituto de Investigaciones Biológicas Clemente Estable, Avda. Italia 3318, Montevideo CP 11600, Uruguay
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Watari S, Wada K, Araki M, Sadahira T, Ousaka D, Oozawa S, Nakatani T, Imai Y, Kato J, Kariyama R, Watanabe T, Nasu Y. Intraluminal diamond-like carbon coating with anti-adhesion and anti-biofilm effects for uropathogens: A novel technology applicable to urinary catheters. Int J Urol 2021; 28:1282-1289. [PMID: 34482564 PMCID: PMC9290946 DOI: 10.1111/iju.14675] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/26/2021] [Indexed: 01/02/2023]
Abstract
Objectives To examine anti‐adhesion and anti‐biofilm effects of a diamond‐like carbon coating deposited via a novel technique on the inner surface of a thin silicon tube. Methods Diamond‐like carbon coatings were deposited into the lumen of a silicon tube with inner diameters of 2 mm. The surface of the diamond‐like carbon was evaluated using physicochemical methods. We used three clinical isolates including green fluorescent protein‐expressing Pseudomonas aeruginosa, Escherichia coli and Staphylococcus aureus. We employed a continuous flow system for evaluation of both bacterial adhesion and biofilm formation. Bacterial adhesion assays consisted of counting the number of colony‐forming units and visualization of adhered bacterial cells by scanning electron microscope to evaluate the diamond‐like carbon‐coated/uncoated samples. The biofilm structure was analyzed by confocal laser scanning microscopy on days 3, 5, 7 and 14 for green fluorescent protein‐expressing Pseudomonas aeruginosa. Results The smooth and carbon‐rich structure of the intraluminal diamond‐like carbon film remained unchanged after the experiments. The numbers of colony‐forming units suggested lower adherence of green fluorescent protein‐expressing Pseudomonas aeruginosa and Escherichia coli in the diamond‐like carbon‐coated samples compared with the uncoated samples. The scanning electron microscope images showed adhered green fluorescent protein‐expressing Pseudomonas aeruginosa cells without formation of microcolonies on the diamond‐like carbon‐coated samples. Finally, biofilm formation on the diamond‐like carbon‐coated samples was lower until at least day 14 compared with the uncoated samples. Conclusions Intraluminal diamond‐like carbon coating on a silicone tube has anti‐adhesion and anti‐biofilm effects. This technology can be applied to urinary catheters made from various materials.
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Affiliation(s)
| | | | | | | | - Daiki Ousaka
- Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Susumu Oozawa
- Division of Clinical Safety Management, Okayama University Hospital, Okayama, Okayama, Japan
| | - Tatsuyuki Nakatani
- Institute of Frontier Science and Technology, Okayama University of Science, Okayama, Okayama, Japan
| | | | - Junichi Kato
- Unit of Biotechnology, Graduate School of Integrated Sciences for Life, Hiroshima University, Higashihiroshima, Hiroshima, Japan
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Pannek J, Pannek-Rademacher S. Usefulness of Hydrastis for the prevention of encrustation of long-term indwelling catheters in persons with neurogenic bladder dysfunction: a case series. Spinal Cord Ser Cases 2021; 7:66. [PMID: 34326303 DOI: 10.1038/s41394-021-00433-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Virtually every person with a spinal cord injury (SCI) suffers from a neurogenic lower urinary tract dysfunction (NLUTD). In the long term, about 15% of persons with SCI depend on indwelling (suprapubic or transurethral) catheters for bladder management. About 50% of these patients suffer from catheter encrustation and blockage, which may become a vital threat for persons with SCI, as it can lead to septicemia or autonomic dysreflexia. Until today, no prophylaxis of catheter encrustations with an evidence-based proof of efficacy exists. CASE PRESENTATION The homeopathic remedy Hydrastis, made from the goldenseal root, is used for the treatment of thick, mucous urine sediment. In four patients with tetraplegia (three female, one male) who managed NLUTD by suprapubic catheters, recurrent encrustations and catheter blockage occurred despite irrigation and medical treatment. Surgical urinary diversion was envisioned. Applying Hydrastis C30 once weekly as a long-term medication, in three of the four patients, catheter obstructions ceased, with a follow-up for at least 1 year. One patient is awaiting ileal conduit surgery. DISCUSSION According to the results of our case series, the application of Hydrastis seems to be beneficial in the prevention of encrustations of indwelling catheters in patients with SCI. As the treatment was effective and well tolerated, the problem is frequent, and effective solutions are scarce, a prospective trial seems justified.
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Affiliation(s)
- Jürgen Pannek
- Neuro-Urologie, Schweizer Paraplegiker-Zentrum, Nottwil, Switzerland.
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25
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Sharma S, Mandhani A, Bose S, Basu B. Dynamically crosslinked polydimethylsiloxane-based polyurethanes with contact-killing antimicrobial properties as implantable alloplasts for urological reconstruction. Acta Biomater 2021; 129:122-137. [PMID: 33979672 DOI: 10.1016/j.actbio.2021.04.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 12/20/2022]
Abstract
A large population of patients is reported to suffer from urinary bladder-associated irreversible physiological disorders, rationalizing a continuous surge for structural and functional substitutes of urinary tissues, including ureters, bladder-wall, and urethra. The current gold standard for bladder reconstruction, an autologous gastrointestinal graft, is proven not to be an ideal substitute in the clinic. While addressing this unmet clinical need, a unique platform of antimicrobial polydimethyl siloxane-modified polyurethanes (TPU/PDMS) is designed and developed for its potential application as a urological implant. To the best of our knowledge, this study reports for the first time the successful integration of varying contents of PDMS within the molten polyurethane matrix using in situ crosslinking methodology. Thus, compatibilized binary blends possess clinically relevant viscoelastic properties to sustain high pressure, large distensions, and surgical manipulation. Furthermore, different chemical strategies are explored to covalently incorporate quaternized moieties, including 4-vinyl pyridine (4-VP), branched-polyethyleneimine (bPEI) as well as bPEI-grafted-(acrylic acid-co-vinylbenzyltriphenyl phosphonium chloride) (PAP), and counter urinary tract infections. The modified compositions, endowed with contact killing surfaces, reveal nearly three log reduction in bacterial growth in pathogenically infected artificial urine. Importantly, the antimicrobial TPU/PDMS blends support the uninhibited growth of mitochondrially viable murine fibroblasts, in a manner comparable to the medical-grade polyurethane. Collectively, the obtained results affirmed the newly developed polymers as promising biomaterials in reconstructive urology. STATEMENT OF SIGNIFICANCE: The clinical procedure for end-stage bladder disease remains replacement or augmentation of the bladder wall with a section of the patient's gastrointestinal tract. However, the absorptive and mucus-producing epithelium of intestinal segment is liable to short- and long-term complications. The dynamically crosslinked polydimethyl siloxane-based polyurethanes proposed herein, and the associated synthesis strategies to induce polycation grafted non-exhaustive contact-killing surfaces against uropathogents, have a significant clinical prospect in reconstructive urology. As an 'off-the-shelf' available alloplastic substitute, these blends offer the potential to circumvent the challenges associated with non-urinary autografts or scaffold based regenerative engineering and, thereby, shorten as well as simplify the surgical treatment. The targeted application has been conceived for a bladder patch to assist in various urinary diseases including, bladder carcinoma, refractory overactive bladder, interstitial cystitis, etc. However, given the ease of fabrication, moldability and the wide spectrum of mechanical properties that could be encompassed, these blends also present the possibility to be manifested into artificial ureteral or urethral conduits.
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Affiliation(s)
- Swati Sharma
- Materials Research Centre, Indian Institute of Science, Bangalore-560012, India
| | - Anil Mandhani
- Urology and Kidney Transplant Institute, Medanta-The Medicity, Gurgaon-12200, India
| | - Suryasarathi Bose
- Department of Materials Engineering, Indian Institute of Science, Bangalore-560012, India.
| | - Bikramjit Basu
- Materials Research Centre, Indian Institute of Science, Bangalore-560012, India; Center for Biosystems Science and Engineering, Indian Institute of Science, Bangalore-560012, India.
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Ellahi A, Stewart F, Kidd EA, Griffiths R, Fernandez R, Omar MI. Strategies for the removal of short-term indwelling urethral catheters in adults. Cochrane Database Syst Rev 2021; 6:CD004011. [PMID: 34184246 PMCID: PMC8240009 DOI: 10.1002/14651858.cd004011.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Urinary catheterisation is a common procedure, with approximately 15% to 25% of all people admitted to hospital receiving short-term (14 days or less) indwelling urethral catheterisation at some point during their care. However, the use of urinary catheters is associated with an increased risk of developing urinary tract infection. Catheter-associated urinary tract infection (CAUTI) is one of the most common hospital-acquired infections. It is estimated that around 20% of hospital-acquired bacteraemias arise from the urinary tract and are associated with mortality of around 10%. This is an update of a Cochrane Review first published in 2005 and last published in 2007. OBJECTIVES To assess the effects of strategies for removing short-term (14 days or less) indwelling catheters in adults. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearching of journals and conference proceedings (searched 17 March 2020), and reference lists of relevant articles. SELECTION CRITERIA We included all randomised controlled trials (RCTs) and quasi-RCTs that evaluated the effectiveness of practices undertaken for the removal of short-term indwelling urethral catheters in adults for any reason in any setting. DATA COLLECTION AND ANALYSIS Two review authors performed abstract and full-text screening of all relevant articles. At least two review authors independently performed risk of bias assessment, data abstraction and GRADE assessment. MAIN RESULTS We included 99 trials involving 12,241 participants. We judged the majority of trials to be at low or unclear risk of selection and detection bias, with a high risk of performance bias. We also deemed most trials to be at low risk of attrition and reporting bias. None of the trials reported on quality of life. The majority of participants across the trials had undergone some form of surgical procedure. Thirteen trials involving 1506 participants compared the removal of short-term indwelling urethral catheters at one time of day (early morning removal group between 6 am to 7 am) versus another (late night removal group between 10 pm to midnight). Catheter removal late at night may slightly reduce the risk of requiring recatheterisation compared with early morning (RR 0.71, 95% CI 0.53 to 0.96; 10 RCTs, 1920 participants; low-certainty evidence). We are uncertain if there is any difference between early morning and late night removal in the risk of developing symptomatic CAUTI (RR 1.00, 95% CI 0.61 to 1.63; 1 RCT, 41 participants; very low-certainty evidence). We are uncertain whether the time of day makes a difference to the risk of dysuria (RR 2.20; 95% CI 0.70 to 6.86; 1 RCT, 170 participants; low-certainty evidence). Sixty-eight trials involving 9247 participants compared shorter versus longer durations of catheterisation. Shorter durations may increase the risk of requiring recatheterisation compared with longer durations (RR 1.81, 95% CI 1.35 to 2.41; 44 trials, 5870 participants; low-certainty evidence), but probably reduce the risk of symptomatic CAUTI (RR 0.52, 95% CI 0.45 to 0.61; 41 RCTs, 5759 participants; moderate-certainty evidence) and may reduce the risk of dysuria (RR 0.42, 95% CI 0.20 to 0.88; 7 RCTs; 1398 participants; low-certainty evidence). Seven trials involving 714 participants compared policies of clamping catheters versus free drainage. There may be little to no difference between clamping and free drainage in terms of the risk of requiring recatheterisation (RR 0.82, 95% CI 0.55 to 1.21; 5 RCTs; 569 participants; low-certainty evidence). We are uncertain if there is any difference in the risk of symptomatic CAUTI (RR 0.99, 95% CI 0.60 to 1.63; 2 RCTs, 267 participants; very low-certainty evidence) or dysuria (RR 0.84, 95% CI 0.46 to 1.54; 1 trial, 79 participants; very low-certainty evidence). Three trials involving 402 participants compared the use of prophylactic alpha blockers versus no intervention or placebo. We are uncertain if prophylactic alpha blockers before catheter removal has any effect on the risk of requiring recatheterisation (RR 1.18, 95% CI 0.58 to 2.42; 2 RCTs, 184 participants; very low-certainty evidence) or risk of symptomatic CAUTI (RR 0.20, 95% CI 0.01 to 4.06; 1 trial, 94 participants; very low-certainty evidence). None of the included trials investigating prophylactic alpha blockers reported the number of participants with dysuria. AUTHORS' CONCLUSIONS There is some evidence to suggest the removal of indwelling urethral catheters late at night rather than early in the morning may reduce the number of people who require recatheterisation. It appears that catheter removal after shorter compared to longer durations probably reduces the risk of symptomatic CAUTI and may reduce the risk of dysuria. However, it may lead to more people requiring recatheterisation. The other evidence relating to the risk of symptomatic CAUTI and dysuria is too uncertain to allow us to draw any conclusions. Due to the low certainty of the majority of the evidence presented here, the results of further research are likely to change our findings and to have a further impact on clinical practice. This systematic review has highlighted the need for a standardised set of core outcomes, which should be measured and reported by all future trials comparing strategies for the removal of short-term urinary catheters. Future trials should also study the effects of short-term indwelling urethral catheter removal on non-surgical patients.
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Affiliation(s)
| | - Fiona Stewart
- c/o Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emily A Kidd
- c/o Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rhonda Griffiths
- School of Nursing and Midwifery, University of Western Sydney, Penrith South DC, Australia
| | - Ritin Fernandez
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Muhammad Imran Omar
- Guidelines Office, European Association of Urology, Arnhem, Netherlands
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
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Srisang S, Boongird A, Ungsurungsie M, Wanasawas P, Nasongkla N. In vivo catheterization study of chlorhexidine-loaded nanoparticle coated Foley urinary catheters in male New Zealand white rabbits. J Biomed Mater Res B Appl Biomater 2021; 109:1836-1843. [PMID: 33856102 DOI: 10.1002/jbm.b.34844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/09/2021] [Accepted: 03/31/2021] [Indexed: 01/07/2023]
Abstract
Foley urinary catheters were coated with chlorhexidine-loaded nanoparticles (CHX-NPs), encapsulated in the form of micelles and nanospheres. Both of nanoparticles were deposited by multilayer nanocoating through dip and spray coating on the catheter surface both inner and outer surface. In our previous studies, the nanocoating of Foley urinary catheters was studied for chlorhexidine release, degradation, antibacterial evaluation, cytotoxicity assessment, hemocompatibility, skin irritation, skin sensitization, and stability during storage. The results demonstrated the antimicrobial functions and biocompatibility of the coated catheters. In this study, coated urinary catheters were inserted in the bladders of rabbits for 7 day to investigate their efficacy. Histopathology results showed no inflammation, redness, or swelling on bladder and urethra tissues. Surface morphology comparison of uncoated catheters in the control group and coated catheters in the treatment group revealed more encrustation and crystallization on uncoated catheter than on coated catheter, indicating that catheters coated with CHX-NPs showed efficacy in delaying encrustation and bacterial colonization. These findings suggest that nanocoating of urinary catheters can potentially enhance the biocompatibility of medical devices.
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Affiliation(s)
- Siriwan Srisang
- Department of Engineering, King Mongkut's Institute of Technology Ladkrabung, Chumphon, Thailand
| | - Atthaporn Boongird
- Department of Surgery, Neurosurgical Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pimpaka Wanasawas
- S&J International Enterprises Public Company Limited, Bangkok, Thailand
| | - Norased Nasongkla
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakhon Pathom, Thailand
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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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Irwin NJ, Trotter JL, Carson L, McCoy CP. Infection-Triggered, Self-Cleaning Surfaces with On-Demand Cleavage of Surface-Localized Surfactant Moieties. ACS Biomater Sci Eng 2021; 7:586-594. [PMID: 33502846 DOI: 10.1021/acsbiomaterials.0c01192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Biofouling of surfaces is a major cause of infection and leads to significant patient morbidity and mortality within healthcare settings. With ever-increasing concerns over antibiotic resistance and associated challenges in eradicating surface-attached biofilm communities, efficacious antifouling materials are urgently required. We herein describe the development of an inherently antiadherent polymer system with the capacity for on-demand cleavage of surface-localized surfactant moieties. The nonionic surfactant, Triton X-100, was linked to hydrogel monomers via hydrolytically labile ester bonds. Synthesized copolymers exhibited pH-dependent switching of surfactant release, with elution triggered under the alkaline conditions characteristic of catheter-associated urinary tract infections and subsequently slowed down as the pH decreased, representing eradication of infection. In addition, the materials demonstrated complete resistance to adherence of Staphylococcus aureus following 24 h incubation in infected artificial urine, with reductions in adherence of Proteus mirabilis of up to 89% also observed. This dual-pronged approach with active, infection-responsive cleavage of surfactant to enhance the antiadherent properties of the surfactant-modified surfaces represents a promising self-cleaning strategy without associated concerns over bacterial resistance.
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Affiliation(s)
- Nicola J Irwin
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, U.K
| | - Johann L Trotter
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, U.K
| | - Louise Carson
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, U.K
| | - Colin P McCoy
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, U.K
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30
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Smith SF, Sengupta A. Balloon bursting: transurethral puncture of a Foley catheter balloon. J Surg Case Rep 2021; 2021:rjaa588. [PMID: 33542814 PMCID: PMC7850073 DOI: 10.1093/jscr/rjaa588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/13/2020] [Accepted: 01/01/2021] [Indexed: 11/14/2022] Open
Abstract
We describe the case of a 76-year-old male who presented with a retained Foley catheter. On the initial attempt to deflate the Foley catheter with a syringe attached to the inflation port, no fluid was aspirated. Using a flexible cystoscope passed alongside the catheter, the balloon was punctured under direct vision with an intravesical needle passed through the cystoscope working channel. We discuss this innovative and safe method for balloon puncture via the transurethral route that can be achieved in the urology outpatient or endoscopy suite.
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Affiliation(s)
- Stephanie F Smith
- Department of Urology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Anup Sengupta
- Department of Urology, West Suffolk Hospital, Bury St Edmunds, UK
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31
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Burns J, McCoy CP, Irwin NJ. Synergistic activity of weak organic acids against uropathogens. J Hosp Infect 2021; 111:78-88. [PMID: 33545217 DOI: 10.1016/j.jhin.2021.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Urinary tract infections (UTIs) are among the most common hospital-acquired infections, with an estimated 75% of UTIs caused by urinary catheters. In addition to the significant healthcare costs and patient morbidity, the escalating antimicrobial resistance reported among common uropathogens make the investigation of efficacious new antimicrobial strategies of urgent importance. AIM To examine the antibacterial activity of a suite of weak organic acids (WOAs) (citric acid, malic acid, propionic acid, mandelic acid, lactic acid, benzoic acid, pyruvic acid and hippuric acid), alone and in combination, against common nosocomial uropathogens (Proteus mirabilis, Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa). METHODS Minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), minimum biofilm eradication concentration (MBEC), fractional inhibitory concentration index (FICI) values and kinetics of bactericidal activity of WOAs were determined by microdilution and time-kill assays. FINDINGS All tested WOAs displayed bactericidal activities against uropathogens in their planktonic and biofilm modes of growth when used individually. Moreover, WOAs in combination displayed synergistic activity against P. mirabilis, S. aureus and E. coli, with reductions in MIC values of up to 250-fold and significant reductions in biofilm formation. CONCLUSION The synergistic multi-mechanistic combinations identified herein are anticipated to play an important role in the treatment and prevention of catheter-associated UTIs.
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Affiliation(s)
- J Burns
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - C P McCoy
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - N J Irwin
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK.
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32
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Amikacin and bacteriophage treatment modulates outer membrane proteins composition in Proteus mirabilis biofilm. Sci Rep 2021; 11:1522. [PMID: 33452316 PMCID: PMC7810710 DOI: 10.1038/s41598-020-80907-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/28/2020] [Indexed: 01/21/2023] Open
Abstract
Modification of outer membrane proteins (OMPs) is the first line of Gram-negative bacteria defence against antimicrobials. Here we point to Proteus mirabilis OMPs and their role in antibiotic and phage resistance. Protein profiles of amikacin (AMKrsv), phage (Brsv) and amikacin/phage (AMK/Brsv) resistant variants of P. mirabilis were compared to that obtained for a wild strain. In resistant variants there were identified 14, 1, 5 overexpressed and 13, 5, 1 downregulated proteins for AMKrsv, Brsv and AMK/Brsv, respectively. Application of phages with amikacin led to reducing the number of up- and downregulated proteins compared to single antibiotic treatment. Proteins isolated in AMKrsv are involved in protein biosynthesis, transcription and signal transduction, which correspond to well-known mechanisms of bacteria resistance to aminoglycosides. In isolated OMPs several cytoplasmic proteins, important in antibiotic resistance, were identified, probably as a result of environmental stress, e.g. elongation factor Tu, asparaginyl-tRNA and aspartyl-tRNA synthetases. In Brsv there were identified: NusA and dynamin superfamily protein which could play a role in bacteriophage resistance. In the resistant variants proteins associated with resistance mechanisms occurring in biofilm, e.g. polyphosphate kinase, flagella basal body rod protein were detected. These results indicate proteins important in the development of P. mirabilis antibiofilm therapies.
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Catheter-Related Bladder Discomfort: How Can We Manage It? Int Neurourol J 2020; 24:324-331. [PMID: 33401353 PMCID: PMC7788325 DOI: 10.5213/inj.2040108.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/10/2020] [Indexed: 12/12/2022] Open
Abstract
The urethral catheter is used in various clinical situations such as diagnosing urologic disease, urine drainage in patients after surgery, and for patients who cannot urinate voluntarily. However, catheters can cause numerous adverse effects, such as catheter-associated infection, obstruction, bladder stones, urethral injury, and catheter-related bladder discomfort (CRBD). CRBD symptoms vary among patients from burning sensation and pain in the suprapubic and penile areas to urinary urgency. CRBD significantly reduces patient quality of life and can lead to several complications. CRBD is caused by catheter-induced bladder irritation due to muscarinic receptor-mediated involuntary contractions of bladder smooth muscle and also can be caused by mechanical stimulus of the urethral catheter. Various pharmacologic studies for managing CRBD, including antimuscarinic and antiepileptic agents and botulinum toxin injections have been reported. If urologists can reduce patients’ CRBD, their quality of life and recovery can improve.
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Bardsley A. Care of patients undergoing removal of an indwelling urinary catheter. Nurs Stand 2020; 35:43-49. [PMID: 32985170 DOI: 10.7748/ns.2020.e11555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 06/11/2023]
Abstract
An indwelling urinary (Foley) catheter may be used in the management of various urological conditions, such as intractable incontinence and urinary retention, or as part of treatment regimens such as chemotherapy. Although some catheters may be required for long-term use, healthcare practitioners should regularly assess whether the device is still necessary and if it can be removed. This is because urinary catheters are a highly invasive intervention and their use is associated with a range of potential complications, including healthcare-associated infection and trauma to the neck of the bladder. This article outlines the procedure for the safe removal of a urinary catheter, including the patient care and monitoring required before, during and after this procedure. It also explains the complications that are associated with catheter removal and how these can be prevented and managed.
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Affiliation(s)
- Alison Bardsley
- School of Nursing, Midwifery & Health, Faculty of Health and Life Sciences, Coventry University, Coventry, England
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Li V, Barker N, Curtis C, Porter B, Panicker JN, Chataway J, Pakzad M. The prevention and management of hospital admissions for urinary tract infection in patients with multiple sclerosis. Mult Scler Relat Disord 2020; 45:102432. [DOI: 10.1016/j.msard.2020.102432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
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Pannek J, Everaert K, Möhr S, Vance W, Van der Aa F, Kesselring J. Tolerability and safety of urotainer® polihexanide 0.02% in catheterized patients: a prospective cohort study. BMC Urol 2020; 20:92. [PMID: 32641131 PMCID: PMC7346619 DOI: 10.1186/s12894-020-00650-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/19/2020] [Indexed: 11/27/2022] Open
Abstract
Background In patients with indwelling bladder catheters for > 2 weeks, bacterial colonization is inevitable, leading to urinary tract infections or encrustations with subsequent catheter blockage. Currently, bladder irrigations are the most frequently used prophylactic means, but the best solution remains yet to be determined. In vitro studies demonstrate that polihexanide is a promising option for catheter irrigation, but no data about safety and tolerability exist. Methods In a prospective observational study in patients with indwelling bladder catheter for > 2 weeks, a 0.02% polihexanide solution was used to rinse the catheter on five consecutive days. Adverse events, tolerability and vital signs were assessed before, during, after and at the end of the treatment period. Results There was no serious adverse event in the study. A total of 28 adverse events (AEs) in 15 (46.88%) participants were experienced. Absolute changes in pain scores were not clinically relevant. No incidences of either flushing or sweating were found during instillation. Bladder spasms during instillation were reported in two cases during a single instillation. Mean pulse rates did not change by more than 3 beats per minute. Mean changes in body temperature did not exceed 0.12 °C. Clinically relevant changes in blood pressure were recorded for 3 patients. Conclusions This is the first study to demonstrate that a 0.02% polihexanide solution can safely be used for catheter irrigation. Trial registration ClinicalTrials.gov (NCT02157415), June 6th, 2014.
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Affiliation(s)
- Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Centre, Guido A. Zäch Strasse 1, CH - 6207, Nottwil, Switzerland. .,Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | | | - Sandra Möhr
- Schweizerisches Paraplegikerzentrum REHAB, Basel, Switzerland
| | - Will Vance
- Urology, Kliniken Beelitz GmbH, Beelitz-Heilstätten, Beelitz, Germany
| | | | - Jürg Kesselring
- Department of Neurology & Neurorehabilitation, Kliniken Valens, Valens, Switzerland
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Wang T, Flint S, Palmer J. Magnesium and calcium ions: roles in bacterial cell attachment and biofilm structure maturation. BIOFOULING 2019; 35:959-974. [PMID: 31687841 DOI: 10.1080/08927014.2019.1674811] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/27/2019] [Indexed: 06/10/2023]
Abstract
The ubiquitous divalent cations magnesium and calcium are important nutrients required by bacteria for growth and cell maintenance. Multi-faceted roles are shown both in bacterial initial attachment and biofilm maturation. The effects of calcium and magnesium can be highlighted in physio-chemical interactions, gene regulation and bio-macromolecular structural modification, which lead to either promotion or inhibition of biofilms. This review outlines recent research addressing phenotypic changes and mechanisms undertaken by calcium and magnesium in affecting bacterial biofilm formation.
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Affiliation(s)
- Tianyang Wang
- Institute of Food Science and Technology, School of Food and Advanced Technology, Massey University, New Zealand
| | - Steve Flint
- Institute of Food Science and Technology, School of Food and Advanced Technology, Massey University, New Zealand
| | - Jon Palmer
- Institute of Food Science and Technology, School of Food and Advanced Technology, Massey University, New Zealand
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Paterson C, Dalziell R, Forshaw T, Turner A, Fraser G. Prevention and management of urinary catheter blockages in community settings. Nurs Stand 2019; 34:e11431. [PMID: 31468913 DOI: 10.7748/ns.2019.e11431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 06/10/2023]
Abstract
Self-management of long-term urinary catheters can be challenging for patients, and recurrent catheter blockages may cause concern among patients, carers and healthcare professionals. Catheter blockages are a significant challenge for nurses practising in community settings, because frequent and unplanned catheter changes can be costly to healthcare services in terms of time and resources. This article details evidence-based recommendations for the assessment and diagnosis of catheter blockages, as well as the identification of risk factors. It also explains the interventions that can be used to prevent and manage catheter blockages and describes the role of the nurse in supporting patients with a long-term catheter in situ in community settings.
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Affiliation(s)
- Catherine Paterson
- School of Nursing, Midwifery & Public Health, Faculty of Health, University of Canberra, Australian Capital Territory, Australia
| | - Rya Dalziell
- University of Canberra, Australian Capital Territory, Australia
| | - Tina Forshaw
- Canberra Health Services, Australian Capital Territory, Australia
| | - Allison Turner
- Canberra Health Services, Australian Capital Territory, Australia
| | - Gillian Fraser
- Canberra Health Services, Australian Capital Territory, Australia
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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: 48] [Impact Index Per Article: 8.0] [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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Optimal Bladder Management Following Spinal Cord Injury: Evidence, Practice and a Cooperative Approach Driving Future Directions in Australia. Arch Phys Med Rehabil 2018; 99:2118-2121. [DOI: 10.1016/j.apmr.2018.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 11/20/2022]
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Albu S, Voidazan S, Bilca D, Badiu M, Truţă A, Ciorea M, Ichim A, Luca D, Moldovan G. Bacteriuria and asymptomatic infection in chronic patients with indwelling urinary catheter: The incidence of ESBL bacteria. Medicine (Baltimore) 2018; 97:e11796. [PMID: 30113467 PMCID: PMC6112905 DOI: 10.1097/md.0000000000011796] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Urinary tract infections due to the presence of a urinary catheter represent a real problem for patients who have to carry such an invasive device for a long time.Our aim was to identify the susceptibility of extended spectrum beta lactamases (ESBL) versus non-ESBL bacteria to antibiotics in urinary tract infections in patients who are chronic carriers of urinary catheters.The retrospective study included a period of 5 years, a total of 405 patients who are chronic carriers of urinary catheters, admitted to rehabilitation and palliative care units.Escherichia coli (E coli) was isolated in 41.2% of patients, Klebsiella pneumoniae (K pneumoniae) in 24.7%, and Proteus mirabilis (P mirabilis) in 15.3%. E coli microbial resistance rates ranged from a minimum of 7.5% (nitrofurantoin) to a maximum of 77.1% (ampicillin). In the case of K pneumoniae, microbial resistance ranged from 34.2% (netilmicin) to 73.2% (ceftriaxone). Resistance rates of P mirabilis ranged from 11.1% (cefepim) to 89.5% (ampicillin). Positivity of ESBL bacteria was identified in 47.4% of patients. Resistance rates of ESBL-positive E coli ranged from 50.0% (ceftriaxone) to 88.1% (cefepime), and ESBL-negative E coli rates ranged from 3.4% (cefepime) to 64.4% (amikacin). Resistance rates of ESBL-positive K pneumoniae ranged between 39.1% (netilmicin) and 85.1% (ceftriaxone), and ESBL-negative K pneumoniae between 7.1% (cefepime) and 53.3% (amikacin). In cases of ESBL-positive P mirabilis, rates ranged from 13.3% (cefepime) to 90.3% (ceftriaxone), whereas in cases of ESBL-negative P mirabilis, rates ranged between 8.3% (cefepime) and 80.0% (trimetroprim).Bacteriuria and asymptomatic catheter infection in chronic carriers is an important public health concern due to the frequent presence of multidrug-resistant bacteria. Our study highlights the need to develop control programs of catheter infections to minimize the risk of infections associated with these medical devices, and also the need for treatment of the infection rather than catheter colonization or contamination.
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Affiliation(s)
| | - Septimiu Voidazan
- Department of Epidemiology, The University of Medicine and Pharmacy of Tîrgu Mureş
| | - Doina Bilca
- Department of Microbiology, S.C. Nova Vita Hospital S.A, Tîrgu Mureş
| | - Monica Badiu
- Department of Microbiology, S.C. Nova Vita Hospital S.A, Tîrgu Mureş
| | - Andreea Truţă
- Department of Microbiology, S.C. Nova Vita Hospital S.A, Tîrgu Mureş
| | - Marian Ciorea
- Department of Microbiology, S.C. Nova Vita Hospital S.A, Tîrgu Mureş
| | - Alin Ichim
- The University of Medicine and Pharmacy of Tîrgu Mureş
| | - Diana Luca
- The University of Medicine and Pharmacy of Tîrgu Mureş
| | - Geanina Moldovan
- Department of Community Nutrition, The University of Medicine and Pharmacy of Tîrgu Mureş, Romania
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Buhmann MT, Abt D, Altenried S, Rupper P, Betschart P, Zumstein V, Maniura-Weber K, Ren Q. Extraction of Biofilms From Ureteral Stents for Quantification and Cultivation-Dependent and -Independent Analyses. Front Microbiol 2018; 9:1470. [PMID: 30050505 PMCID: PMC6052902 DOI: 10.3389/fmicb.2018.01470] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/12/2018] [Indexed: 12/21/2022] Open
Abstract
Ureteral stenting is a common surgical procedure, which is associated with a high morbidity and economic burden, but the knowledge on the link between biofilms on these stents, morbidity, and the impact of the involved microbiota is still limited. This is partially due to a lack of methods that allow for a controlled extraction of the biofilms from stents. Development of an appropriate in vitro model to assess prevention of biofilm formation by antimicrobial coatings and biomaterials requires a profound understanding of the biofilm composition, including the involved microbiota. This work describes an analytical pipeline for the extraction of native biofilms from ureteral stents for both cultivation-dependent and -independent analysis, involving a novel mechanical abrasion method of passing stent samples through a tapered pinhole. The efficiency of this novel method was evaluated by quantifying the removed biofilm mass, numbers of cultivable bacteria, calcium content, and microscopic stent analysis after biofilm removal using 30 clinical stent samples. Furthermore, the extraction of in vitro formed Escherichia coli biofilms was evaluated by universal 16S quantitative PCR, a cultivation-independent method to demonstrate efficient biofilm removal by the new approach. The novel method enables effective contamination-free extraction of the biofilms formed on ureteral stents and their subsequent quantification, and it represents a useful tool for comprehensive examinations of biofilms on ureteral stents.
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Affiliation(s)
- Matthias T. Buhmann
- Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | - Dominik Abt
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Stefanie Altenried
- Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | - Patrick Rupper
- Laboratory for Advanced Fibers, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | - Patrick Betschart
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Valentin Zumstein
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Katharina Maniura-Weber
- Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | - Qun Ren
- Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
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Frant M, Dayyoub E, Bakowsky U, Liefeith K. Evaluation of a ureteral catheter coating by means of a BioEncrustation in vitro model. Int J Pharm 2018; 546:86-96. [PMID: 29752980 DOI: 10.1016/j.ijpharm.2018.04.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 02/01/2023]
Abstract
Biomaterials for applications in the urinary tract are challenged with both biofilm formation and encrustation, two highly interconnected processes. While great effort has been achieved developing promising materials there is only a limited choice of sophisticated in vitro models that are available to analyse the performance of biomaterials prior to performing delicate and expensive in vivo studies. In this study we present a complex BioEncrustation model that imitates both the processes of multi-species biofilm formation and encrustation in vitro. The resulting crystalline biofilms are compared to the deposits found on explanted ureteral stent surfaces (in vivo situation) and to deposits formed in an experimental set up that does not contain bacteria (Encrustator®). Further focus of this study is dedicated to employing the developed BioEncrustation model to evaluate the effect multifunctional coatings impose on the processes of biofilm formation and encrustation under in vitro conditions. The investigated TANP coating combines unspecific and broad band specific antibacterial properties with a degrading polymer matrix that is intended to inhibit crystal formation. The coating was prepared on both polyurethane and silicone tubes and the subsequent results of the in vitro BioEncrustation analyses reveal a promising potential for employing the coating to render ureteral stent surfaces more biocompatible.
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Affiliation(s)
- M Frant
- Department of Biomaterials, Institute for Bioprocessing and Analytical Measurement Techniques e.V. (iba), Rosenhof, 37308 Heilbad Heiligenstadt, Germany
| | - E Dayyoub
- Department of Pharmaceutical Technology and Biopharmaceutics, Marburg University, 35037 Marburg, Germany
| | - U Bakowsky
- Department of Pharmaceutical Technology and Biopharmaceutics, Marburg University, 35037 Marburg, Germany
| | - K Liefeith
- Department of Biomaterials, Institute for Bioprocessing and Analytical Measurement Techniques e.V. (iba), Rosenhof, 37308 Heilbad Heiligenstadt, Germany.
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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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Shepherd AJ, Mackay WG, Hagen S. Catheter washout solutions for long-term urinary catheterisation in adults: A Cochrane review summary. Int J Nurs Stud 2018; 82:167-170. [PMID: 29510831 DOI: 10.1016/j.ijnurstu.2017.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - William Gordon Mackay
- Institute of Healthcare Policy and Practice, University of the West of Scotland, United Kingdom
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, United Kingdom
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Zabłotni A, Matusiak D, Arbatsky NP, Moryl M, Maciejewska A, Kondakova AN, Shashkov AS, Ługowski C, Knirel YA, Różalski A. Changes in the lipopolysaccharide of Proteus mirabilis 9B-m (O11a) clinical strain in response to planktonic or biofilm type of growth. Med Microbiol Immunol 2018; 207:129-139. [PMID: 29330591 PMCID: PMC5878192 DOI: 10.1007/s00430-018-0534-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/02/2018] [Indexed: 11/18/2022]
Abstract
The impact of planktonic and biofilm lifestyles of the clinical isolate Proteus mirabilis 9B-m on its lipopolysaccharide (O-polysaccharide, core region, and lipid A) was evaluated. Proteus mirabilis bacteria are able to form biofilm and lipopolysaccharide is one of the factors involved in the biofilm formation. Lipopolysaccharide was isolated from planktonic and biofilm cells of the investigated strain and analyzed by SDS–PAGE with silver staining, Western blotting and ELISA, as well as NMR and matrix-assisted laser desorption ionization time-of-flight mass spectrometry techniques. Chemical and NMR spectroscopic analyses revealed that the structure of the O-polysaccharide of P. mirabilis 9B-m strain did not depend on the form of cell growth, but the full-length chains of the O-antigen were reduced when bacteria grew in biofilm. The study also revealed structural modifications of the core region in the lipopolysaccharide of biofilm-associated cells—peaks assigned to compounds absent in cells from the planktonic culture and not previously detected in any of the known Proteus core oligosaccharides. No differences in the lipid A structure were observed. In summary, our study demonstrated for the first time that changes in the lifestyle of P. mirabilis bacteria leads to the modifications of their important virulence factor—lipopolysaccharide.
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Affiliation(s)
- Agnieszka Zabłotni
- Laboratory of General Microbiology, Department of Biology of Bacteria, Institute of Microbiology, Biotechnology and Immunology, University of Łódź, Banacha 12/16, 90-237, Łódź, Poland.
| | - Dominik Matusiak
- Laboratory of General Microbiology, Department of Biology of Bacteria, Institute of Microbiology, Biotechnology and Immunology, University of Łódź, Banacha 12/16, 90-237, Łódź, Poland
| | - Nikolay P Arbatsky
- N. D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospekt 47, 119991, Moscow, Russia
| | - Magdalena Moryl
- Department of Biology of Bacteria, Institute of Microbiology, Biotechnology and Immunology, University of Łódź, Banacha 12/16, 90-237, Łódź, Poland
| | - Anna Maciejewska
- Department of Immunochemistry, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Rudolf Weigl 12, 53-114, Wrocław, Poland
| | - Anna N Kondakova
- N. D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospekt 47, 119991, Moscow, Russia
| | - Alexander S Shashkov
- N. D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospekt 47, 119991, Moscow, Russia
| | - Czesław Ługowski
- Department of Immunochemistry, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Rudolf Weigl 12, 53-114, Wrocław, Poland
| | - Yuriy A Knirel
- N. D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospekt 47, 119991, Moscow, Russia
| | - Antoni Różalski
- Department of Biology of Bacteria, Institute of Microbiology, Biotechnology and Immunology, University of Łódź, Banacha 12/16, 90-237, Łódź, Poland
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McCoy CP, Irwin NJ, Donnelly L, Jones DS, Hardy JG, Carson L. Anti-Adherent Biomaterials for Prevention of Catheter Biofouling. Int J Pharm 2017; 535:420-427. [PMID: 29170113 DOI: 10.1016/j.ijpharm.2017.11.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/13/2017] [Accepted: 11/20/2017] [Indexed: 01/12/2023]
Abstract
Medical device-associated infections present a leading global healthcare challenge, and effective strategies to prevent infections are urgently required. Herein, we present an innovative anti-adherent hydrogel copolymer as a candidate catheter coating with complementary hydrophobic drug-carrying and eluting capacities. The amphiphilic block copolymer, Poloxamer 188, was chemically-derivatized with methacryloyl moieties and copolymerized with the hydrogel monomer, 2-hydroxyethyl methacrylate. Performance of the synthesized copolymers was evaluated in terms of equilibrium swelling, surface water wettability, mechanical integrity, resistance to encrustation and bacterial adherence, and ability to control release of the loaded fluoroquinolone antibiotic, ofloxacin. The developed matrices were able to provide significant protection from fouling, with observed reductions of over 90% in both adherence of the common urinary pathogen Escherichia coli and encrusting crystalline deposits of calcium and magnesium salts relative to the commonly employed hydrogel, poly (hydroxyethyl methacrylate). Additionally, the release kinetics of a loaded hydrophobic drug could be readily tuned through facile manipulation of polymer composition. This combinatorial approach shows significant promise in the development of suitable systems for prevention of catheter-associated infections.
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Affiliation(s)
- Colin P McCoy
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, UK.
| | - Nicola J Irwin
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, UK
| | - Louise Donnelly
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, UK
| | - David S Jones
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, UK
| | - John G Hardy
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, UK
| | - Louise Carson
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, UK
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Wilde MH, McMahon JM, Crean HF, Brasch J. Exploring relationships of catheter-associated urinary tract infection and blockage in people with long-term indwelling urinary catheters. J Clin Nurs 2017; 26:2558-2571. [PMID: 27805758 PMCID: PMC5413425 DOI: 10.1111/jocn.13626] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To describe and explore relationships among catheter problems in long-term indwelling urinary catheter users, including excess healthcare use for treating catheter problems. BACKGROUND Long-term urinary catheter users experience repeated problems with catheter-related urinary tract infection and blockage of the device, yet little has been reported of the patterns and relationships among relevant catheter variables. DESIGN Secondary data analysis was conducted from a sample in a randomised clinical trial, using data from the entire sample of 202 persons over 12 months' participation. METHODS Descriptive statistics were used to characterise the sample over time. Zero-inflated negative binomial models were employed for logistic regressions to evaluate predictor variables of the presence/absence and frequencies of catheter-related urinary tract infection and blockage. RESULTS Catheter-related urinary tract infection was marginally associated with catheter blockage. Problems reported at least once per person in the 12 months were as follows: catheter-related urinary tract infection 57%, blockage 34%, accidental dislodgment 28%, sediment 87%, leakage (bypassing) 67%, bladder spasms 59%, kinks/twists 42% and catheter pain 49%. Regression analysis demonstrated that bladder spasms were significantly related to catheter-related urinary tract infection and sediment amount, and catheter leakages were marginally significantly and positively related to catheter-related urinary tract infection. Frequencies of higher levels of sediment and catheter leakage were significantly associated with higher levels of blockage, and being female was associated with fewer blockages. Persons who need help with eating (more disabled) were also more likely to have blockages. CONCLUSIONS Catheter-related urinary tract infection and blockage appear to be related and both are associated with additional healthcare expenditures. More research is needed to better understand how to prevent adverse catheter outcomes and patterns of problems in subgroups. RELEVANCE TO CLINICAL PRACTICE Nurses can develop care management strategies to identify catheter blockage prior to its occurrence by tracking the amount of sediment and frequency of leakage. Bladder spasms could be an early warning of catheter-related urinary tract infection.
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Affiliation(s)
- Mary H Wilde
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - James M McMahon
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Hugh F Crean
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Judith Brasch
- School of Nursing, University of Rochester, Rochester, NY, USA
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Antibacterial and anti-encrustation biodegradable polymer coating for urinary catheter. Int J Pharm 2017; 531:205-214. [PMID: 28830785 DOI: 10.1016/j.ijpharm.2017.08.072] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/09/2017] [Indexed: 11/22/2022]
Abstract
Bacterial biofilm and crystalline deposits are the common causes of failure of long-term indwelling urinary catheter. Bacteria colonise the catheter surface causing serious infections in the urinary tract and encrustations that can block the catheter and induce trauma in patients. In this study, the strategy used to resist bacterial adhesion and encrustation represents a combination of the antibacterial effects of norfloxacin and silver nanoparticles and the PLGA-based neutralisation of alkali products of urea hydrolysis gained through the degradation of the polymer in an aqueous milieu. Silver nanoparticles were coated with tetraether lipids (TEL) to avoid aggregation when dispersed in acetone and during the film formation. The polymer films loaded with the two antibacterial agents were applied on Polyurethane (PUR) and Silicon sheets. We demonstrated the antibacterial and anti-adhesion effectiveness of the coatings whereby commercially available biocompatible polymers PUR and Silicon were used as controls. Using artificial urine and an in vitro encrustation model, it was shown that the coatings resist the encrustation for at least 2 weeks. This combination of a biodegradable polymer and wide-range antibacterial agents represents a potentially attractive biocompatible coating for urinary catheters.
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Abstract
Community care is at the forefront of the National Health Service reforms. Role redistribution from registered nurses to health care assistants is growing. This paper examines the challenges of upskilling community health care assistants to undertake catheterisation for uncomplicated patients in the community. Social constructivist methods facilitated reflective practice. Challenges included fears around delegation, accountability and the responsibilities involved in supporting the development of health care assistants. Recommendations suggest that community health care assistants offer a valuable and much needed contribution to health care delivery and are enthusiastic to upskill in catheterisation. However, reluctance from community registered nurses around delegation delayed the process. Registered nurses will need to address these fears and engage in workforce planning to proactively influence role developments and safe practice. National guidance needs to be structured around clear pathways to support these valued participants in delivering health care.
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