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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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2
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Wakefield A. Use of indwelling catheters and preventing catheter-associated urinary tract infections. Nurs Stand 2021; 36:77-82. [PMID: 33787158 DOI: 10.7748/ns.2021.e11594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
Indwelling urinary catheters are considered an important healthcare intervention for many patients. However, these devices must be used with caution because they are associated with a risk of various potential complications such as catheter-associated urinary tract infections (CAUTIs), as well as a financial burden for healthcare organisations. This article outlines the various types of indwelling catheter that are available, explains the reasons for their use, and details the care required to prevent associated complications, particularly CAUTIs.
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Affiliation(s)
- Ann Wakefield
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, England
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3
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Abstract
The indwelling urethral catheter remains an integral part of contemporary medical care, despite its significant design shortcomings. Urethral catheterisation is responsible for well-recognised complications including catheter-associated urinary tract infection (CAUTI), catheter-associated urethral injury (CAUI), catheter blockage, and bladder mucosal irritation. In this narrative review, we provide an update on current innovations in urethral catheter design, aimed at safeguarding against these complications. There is an obvious need to improve catheter technology and urologists should support the translation of innovations into clinical practice.
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4
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Pelling H, Nzakizwanayo J, Milo S, Denham EL, MacFarlane WM, Bock LJ, Sutton JM, Jones BV. Bacterial biofilm formation on indwelling urethral catheters. Lett Appl Microbiol 2019; 68:277-293. [PMID: 30811615 DOI: 10.1111/lam.13144] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 12/21/2022]
Abstract
Urethral catheters are the most commonly deployed medical devices and used to manage a wide range of conditions in both hospital and community care settings. The use of long-term catheterization, where the catheter remains in place for a period >28 days remains common, and the care of these patients is often undermined by the acquisition of infections and formation of biofilms on catheter surfaces. Particular problems arise from colonization with urease-producing species such as Proteus mirabilis, which form unusual crystalline biofilms that encrust catheter surfaces and block urine flow. Encrustation and blockage often lead to a range of serious clinical complications and emergency hospital referrals in long-term catheterized patients. Here we review current understanding of bacterial biofilm formation on urethral catheters, with a focus on crystalline biofilm formation by P. mirabilis, as well as approaches that may be used to control biofilm formation on these devices. SIGNIFICANCE AND IMPACT OF THE STUDY: Urinary catheters are the most commonly used medical devices in many healthcare systems, but their use predisposes to infection and provide ideal conditions for bacterial biofilm formation. Patients managed by long-term urethral catheterization are particularly vulnerable to biofilm-related infections, with crystalline biofilm formation by urease producing species frequently leading to catheter blockage and other serious clinical complications. This review considers current knowledge regarding biofilm formation on urethral catheters, and possible strategies for their control.
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Affiliation(s)
- H Pelling
- Department of Biology and Biochemistry, University of Bath, Claverton Down, Bath, UK
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - J Nzakizwanayo
- Department of Biology and Biochemistry, University of Bath, Claverton Down, Bath, UK
| | - S Milo
- Department of Chemistry, University of Bath, Claverton Down, Bath, UK
| | - E L Denham
- Department of Biology and Biochemistry, University of Bath, Claverton Down, Bath, UK
| | - W M MacFarlane
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - L J Bock
- National Infections Service, Public Health England, Porton Down, Salisbury, UK
| | - J M Sutton
- National Infections Service, Public Health England, Porton Down, Salisbury, UK
| | - B V Jones
- Department of Biology and Biochemistry, University of Bath, Claverton Down, Bath, UK
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5
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Milo S, Nzakizwanayo J, Hathaway HJ, Jones BV, Jenkins ATA. Emerging medical and engineering strategies for the prevention of long-term indwelling catheter blockage. Proc Inst Mech Eng H 2018; 233:68-83. [PMID: 29807465 DOI: 10.1177/0954411918776691] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Urinary catheters have been used on an intermittent or indwelling basis for centuries, in order to relieve urinary retention and incontinence. Nevertheless, the use of urinary catheters in the clinical setting is fraught with complication, the most common of which is the development of nosocomial urinary tract infections, known as catheter-associated urinary tract infections. Infections of this nature are not only significant owing to their high incidence rate and subsequent economic burden but also to the severe medical consecutions that result. A range of techniques have been employed in recent years, utilising various technologies in attempts to counteract the perilous medical cascade following catheter blockage. This review will focus on the current advancement (within the last 10 years) in prevention of encrustation and blockage of long-term indwelling catheters both from engineering and medical perspectives, with particular emphasis on the importance of stimuli-responsive systems.
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Affiliation(s)
- Scarlet Milo
- 1 Department of Chemistry, University of Bath, Bath, UK
| | - Jonathan Nzakizwanayo
- 2 School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | | | - Brian V Jones
- 4 Department of Biology and Biochemistry, University of Bath, UK
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6
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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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Surender EM, Bradberry SJ, Bright SA, McCoy CP, Williams DC, Gunnlaugsson T. Luminescent Lanthanide Cyclen-Based Enzymatic Assay Capable of Diagnosing the Onset of Catheter-Associated Urinary Tract Infections Both in Solution and within Polymeric Hydrogels. J Am Chem Soc 2016; 139:381-388. [DOI: 10.1021/jacs.6b11077] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Esther M. Surender
- School
of Chemistry, Trinity Biomedical Sciences Institute (TBSI), Trinity
College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Samuel J. Bradberry
- School
of Chemistry, Trinity Biomedical Sciences Institute (TBSI), Trinity
College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Sandra A. Bright
- School
of Biochemistry and Immunology, Trinity Biomedical Sciences Institute
(TBSI), Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Colin P. McCoy
- School
of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, U.K
| | - D. Clive Williams
- School
of Biochemistry and Immunology, Trinity Biomedical Sciences Institute
(TBSI), Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Thorfinnur Gunnlaugsson
- School
of Chemistry, Trinity Biomedical Sciences Institute (TBSI), Trinity
College Dublin, The University of Dublin, Dublin 2, Ireland
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Maeda S, Takiuti T, Kohno Y, Nakai H, Fukuda M, Moriyama MT. Catheter blockage factors in patients cared for in their own home requiring long-term urinary catheterisation. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2016. [DOI: 10.1111/ijun.12123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shuko Maeda
- Nursing Department; Kanazawa Medical University; Kahoku Japan
| | - Takako Takiuti
- Nursing Department; Kanazawa Medical University; Kahoku Japan
| | - Yumiko Kohno
- Nursing Department; Kanazawa Medical University; Kahoku Japan
| | - Hisao Nakai
- Nursing Department; Kanazawa Medical University; Kahoku Japan
| | | | - Manabu T. Moriyama
- Department of Urology, Himi Municipal Hospital; Kanazawa Medical University; Kahoku Japan
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9
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Milo S, Thet NT, Liu D, Nzakizwanayo J, Jones BV, Jenkins ATA. An in-situ infection detection sensor coating for urinary catheters. Biosens Bioelectron 2016; 81:166-172. [PMID: 26945183 PMCID: PMC4833687 DOI: 10.1016/j.bios.2016.02.059] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 01/23/2023]
Abstract
We describe a novel infection-responsive coating for urinary catheters that provides a clear visual early warning of Proteus mirabilis infection and subsequent blockage. The crystalline biofilms of P. mirabilis can cause serious complications for patients undergoing long-term bladder catheterisation. Healthy urine is around pH 6, bacterial urease increases urine pH leading to the precipitation of calcium and magnesium deposits from the urine, resulting in dense crystalline biofilms on the catheter surface that blocks urine flow. The coating is a dual layered system in which the lower poly(vinyl alcohol) layer contains the self-quenching dye carboxyfluorescein. This is capped by an upper layer of the pH responsive polymer poly(methyl methacrylate-co-methacrylic acid) (Eudragit S100®). Elevation of urinary pH (>pH 7) dissolves the Eudragit layer, releasing the dye to provide a clear visual warning of impending blockage. Evaluation of prototype coatings using a clinically relevant in vitro bladder model system demonstrated that coatings provide up to 12 h advanced warning of blockage, and are stable both in the absence of infection, and in the presence of species that do not cause catheter blockage. At the present time, there are no effective methods to control these infections or provide warning of impending catheter blockage. Development of a dual-layered diagnostic coating sensor for urinary catheter. Provides advance warning of infection by P. mirabilis in response to alkaline urine. Read out via release of carboxyfluorescein dye from coating into urine leg bag. Catheter prototypes ‘report’ infection 12 h before blockage by P. mirablis.
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Affiliation(s)
- Scarlet Milo
- Department of Chemistry, University of Bath, Bath BA2 7AY, UK
| | - Naing Tun Thet
- Department of Chemistry, University of Bath, Bath BA2 7AY, UK
| | - Dan Liu
- Department of Chemistry, University of Bath, Bath BA2 7AY, UK
| | | | - Brian V Jones
- School of Pharmacy and Biomolecular Sciences, University of Brighton, BN2 4GJ, UK; Queen Victoria Hospital NHS Foundation Trust, East Grinstead RH19 3DZ, UK
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10
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Corrie SR, Coffey JW, Islam J, Markey KA, Kendall MAF. Blood, sweat, and tears: developing clinically relevant protein biosensors for integrated body fluid analysis. Analyst 2016; 140:4350-64. [PMID: 25909342 DOI: 10.1039/c5an00464k] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Biosensors are being developed to provide rapid, quantitative, diagnostic information to clinicians in order to help guide patient treatment, without the need for centralised laboratory assays. The success of glucose monitoring is a key example of where technology innovation has met a clinical need at multiple levels – from the pathology laboratory all the way to the patient's home. However, few other biosensor devices are currently in routine use. Here we review the challenges and opportunities regarding the integration of biosensor techniques into body fluid sampling approaches, with emphasis on the point-of-care setting.
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Affiliation(s)
- S R Corrie
- The University of Queensland, Australian Institute for Bioengineering and Nanotechnology, Delivery of Drugs and Genes Group (D2G2), St Lucia, Queensland 4072, Australia.
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