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Di Bello F, Califano G, Morra S, Ruvolo CC, Fraia A, Pezone G, Di Mauro E, Aprea S, Napolitano L, Saccone G, Creta M, Longo N. Urological Challenges during Pregnancy: Current Status and Future Perspective on Ureteric Stent Encrustation. J Clin Med 2024; 13:3905. [PMID: 38999471 PMCID: PMC11242795 DOI: 10.3390/jcm13133905] [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: 06/11/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
The management of ureter hydronephrosis and urolithiasis during pregnancy has been changed by the adoption of ureteric stents. Despite their broad use for several other conditions, from emergency to elective settings, their complications cannot be ignored. Being most prevalent during pregnancy, urinary tract infections and stent encrustations are particularly common and can affect either fetal growth or maternal-fetal homeostasis, leading to obstetric complications. The main concern associated with ureteric stents is the indwelling time, which could represent the potential trigger of those complications. However, to ensure the optimal management of a ureteric stent during pregnancy, factors such as the grading of encrustations and the presence, size, and location of stones should be evaluated in pre-operative planning. As a consequence, a multimodal approach, including obstetrics, gynecologists, urologists, and nurses, is essential to ensure a complication-free procedure and successful ureteric stent removal. Finally, future research should focus on utilizing biodegradable and biocompatible materials to reduce and even eliminate the complications related to forgotten stents in order to reduce the financial burden associated with stent replacement and the management of stent-encrustation-related complications.
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Affiliation(s)
- Francesco Di Bello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Simone Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Agostino Fraia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Gabriele Pezone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Ernesto Di Mauro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Salvatore Aprea
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Gabriele Saccone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
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Radu VD, Costache RC, Onofrei P, Miron A, Bandac CA, Arseni D, Mironescu M, Miftode RS, Boiculese LV, Miftode IL. Urinary Tract Infections with Carbapenem-Resistant Klebsiella pneumoniae in a Urology Clinic-A Case-Control Study. Antibiotics (Basel) 2024; 13:583. [PMID: 39061265 PMCID: PMC11274011 DOI: 10.3390/antibiotics13070583] [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: 05/27/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The aim of our study was to analyze the factors associated with the increased risk of urinary tract infection (UTI) with carbapenem-resistant (CR) Klebsiella pneumoniae (Kpn) and the antibiotic resistance spectrum of the strains in patients. As secondary objectives, we elaborated the profile of these patients and the incidence of different types of carbapenemases. METHODS We conducted a retrospective case-control study in which we compared a group of 62 patients with urinary tract infections with CR Kpn with a control group consisting of 136 patients with urinary tract infections with multidrug-resistant (MDR), but carbapenem-sensitive (CS), Kpn, who were hospitalized between 1 January 2022 and 31 March 2024. RESULTS Compared to patients with urinary tract infections with CS Kpn, patients with urinary tract infections with CR Kpn were preponderant in rural areas (62.9% vs. 47.1%, p = 0.038) and more frequently had an upper urinary tract infection (69.4% vs. 36.8%, p < 0.01). Among the risk factors examined, patients in the study group had a higher presence of urinary catheters inserted for up to one month (50% vs. 34.6%, p = 0.03), rate of hospitalization in the last 180 days (96.8% vs. 69.9%, p < 0.01) and incidence of antibiotic therapy in the last 180 days (100% vs. 64.7%, p < 0.01). They also had a higher rate of carbapenem treatment in the last 180 days (8.1% vs. 0%, p < 0.01). Patients in the study group had a broader spectrum of resistance to all antibiotics tested (p < 0.01), with the exception of sulfamethoxazole-trimethoprim, where the resistance rate was similar in both groups (80.6% vs. 67.6%, p = 0.059). In the multivariate analysis, transfer from other hospitals (OR = 3.51, 95% and CI: 1.430-8.629) and treatment with carbapenems in the last 180 days (OR = 11.779 and 95% CI: 1.274-108.952) were factors associated with an increased risk of disease compared to the control group. The presence of carbapenemases was observed in all patients with CR Kpn, in the order of frequency New Delhi metallo-ß-lactamase (NDM) (52.2%), Klebsiella pneumoniae carbapenemase (KPC) (32.6%), and carbapenem-hydrolyzing oxacillinase (Oxa-48) (15.2%). CONCLUSIONS The environment of origin and previous treatment with carbapenems appear to be the factors associated with an increased risk of urinary tract infection with CR Kpn compared to patients with urinary tract infections with CS Kpn. CR Kpn exhibits a broad spectrum of antibiotic resistance, among which is resistance to carbapenem antibiotics.
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Affiliation(s)
- Viorel Dragos Radu
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (V.D.R.); (R.C.C.); (A.M.)
- Department of Urology and Renal Transplantation, “C.I. Parhon” University Hospital, 700115 Iasi, Romania; (C.-A.B.); (D.A.); (M.M.)
| | - Radu Cristian Costache
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (V.D.R.); (R.C.C.); (A.M.)
- Department of Urology and Renal Transplantation, “C.I. Parhon” University Hospital, 700115 Iasi, Romania; (C.-A.B.); (D.A.); (M.M.)
| | - Pavel Onofrei
- Department of Morpho-Functional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
- Department of Urology, Elytis Hope Hospital, 700010 Iasi, Romania
| | - Adelina Miron
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (V.D.R.); (R.C.C.); (A.M.)
- Department of Urology and Renal Transplantation, “C.I. Parhon” University Hospital, 700115 Iasi, Romania; (C.-A.B.); (D.A.); (M.M.)
| | - Carina-Alexandra Bandac
- Department of Urology and Renal Transplantation, “C.I. Parhon” University Hospital, 700115 Iasi, Romania; (C.-A.B.); (D.A.); (M.M.)
| | - Daniel Arseni
- Department of Urology and Renal Transplantation, “C.I. Parhon” University Hospital, 700115 Iasi, Romania; (C.-A.B.); (D.A.); (M.M.)
| | - Mihaela Mironescu
- Department of Urology and Renal Transplantation, “C.I. Parhon” University Hospital, 700115 Iasi, Romania; (C.-A.B.); (D.A.); (M.M.)
| | - Radu-Stefan Miftode
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Lucian Vasile Boiculese
- Department of Preventive and Interdisciplinarity, Medical Informatics and Biostatistics, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Ionela-Larisa Miftode
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
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Ghaffari S, Amiri N, Felix DF, Abbasidezfouli S, Franco F, Beaupré SL, Branda NR, Lange D. Surface photosterilization of implantable silicone biomaterials: structural and functional characterization. Colloids Surf B Biointerfaces 2024; 233:113637. [PMID: 37979481 DOI: 10.1016/j.colsurfb.2023.113637] [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: 08/12/2023] [Revised: 10/16/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
Hospital-acquired infections (HAIs) remain one of the major challenges faced by the global healthcare system. The increasing rate of pathogenic resistance against antibiotics suggests that alternative treatments are needed to control recurrent infections. Catheter-associated urinary tract infections (CAUTIs) are the third most common type of HAI worldwide, and this is mainly due to indwelling devices being excellent substrates for bacterial adhesion and growth. Subsequent biofilm formation on the implant surface acts as a constant nidus of bacteria and infection, thereby contributing to increased rates of patient morbidity and mortality. Here, we propose a simple and cost-effective method to sterilize silicone-based implant surfaces and prevent initial bacterial colonization, using Polydimethylsiloxane (PDMS) and an embedded ruthenium photosensitizer (PS). Exposure to LED light triggers potent photokilling action, resulting in significant bactericidal activity as evidenced by the number of adherent bacteria being below the level of detection (<10 CFU/mL) after 24 h. Live/dead staining studies using fluorescence microscopy indicated significant reduction in surface-adhered bacterial growth and biofilm formation. This potent antibacterial activity was verified in vivo, with exposure of contaminated PDMS coupons containing PS to LED prior to implantation resulting in over 99.5% reduction in adherent bacteria compared to controls over the 3-day implantation period. Histological analysis of the implantation site of PDMS+PS samples, in the absence of bacteria, revealed no adverse reactions. This was also confirmed using in vitro cytotoxicity studies. Tensile strength, surface roughness, hydrophobicity, and the development of encrustation of surface-treated groups exhibit comparable or improved properties to bare PDMS.
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Affiliation(s)
- Sahand Ghaffari
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Jack Bell Research Centre, 550-3, 2660 Oak Street, Vancouver V6H 3Z6, BC, Canada.
| | - Nafise Amiri
- ICORD and Department of Pathology and Laboratory Medicine, University of British Columbia, 818 W10th Ave, Vancouver V5Z 1M9, Canada.
| | - Demian F Felix
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Jack Bell Research Centre, 550-3, 2660 Oak Street, Vancouver V6H 3Z6, BC, Canada.
| | - Samin Abbasidezfouli
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Jack Bell Research Centre, 550-3, 2660 Oak Street, Vancouver V6H 3Z6, BC, Canada.
| | - Fernanda Franco
- 4D LABS and Department of Chemistry, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Scott L Beaupré
- Department of Physics, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Neil R Branda
- 4D LABS and Department of Chemistry, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Dirk Lange
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Jack Bell Research Centre, 550-3, 2660 Oak Street, Vancouver V6H 3Z6, BC, Canada.
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Cleaver L, Garnett JA. How to study biofilms: technological advancements in clinical biofilm research. Front Cell Infect Microbiol 2023; 13:1335389. [PMID: 38156318 PMCID: PMC10753778 DOI: 10.3389/fcimb.2023.1335389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
Biofilm formation is an important survival strategy commonly used by bacteria and fungi, which are embedded in a protective extracellular matrix of organic polymers. They are ubiquitous in nature, including humans and other animals, and they can be surface- and non-surface-associated, making them capable of growing in and on many different parts of the body. Biofilms are also complex, forming polymicrobial communities that are difficult to eradicate due to their unique growth dynamics, and clinical infections associated with biofilms are a huge burden in the healthcare setting, as they are often difficult to diagnose and to treat. Our understanding of biofilm formation and development is a fast-paced and important research focus. This review aims to describe the advancements in clinical biofilm research, including both in vitro and in vivo biofilm models, imaging techniques and techniques to analyse the biological functions of the biofilm.
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Affiliation(s)
- Leanne Cleaver
- Centre for Host-Microbiome Interactions, Faculty of Dental, Oral & Craniofacial Sciences, King’s College London, London, United Kingdom
| | - James A. Garnett
- Centre for Host-Microbiome Interactions, Faculty of Dental, Oral & Craniofacial Sciences, King’s College London, London, United Kingdom
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Bouassida K, Marzouk M, Nouir S, Ghammem R, Sahtout W, Ghardallou M, Fathallah N, Boukadida J, Jaidane M, Slim R, Zaïri A. Analysis of Pathogens of Urinary Tract Infections Associated with Indwelling Double-J Stents and Their Susceptibility to Globularia alypum. Pharmaceutics 2023; 15:2496. [PMID: 37896256 PMCID: PMC10609942 DOI: 10.3390/pharmaceutics15102496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Ureteral double-J stents are frequently used to prevent urinary obstruction. They can develop bacterial colonization and encrustation, which leads to persistent infections that seldom respond to antibiotic treatment. Thus, the goal of this study was to evaluate the local spectrum of bacterial pathogens and their susceptibility to natural compounds. A total of 59 double-J ureteral stents from 59 consecutive patients were examined. The samples were inoculated on agar culture mediums. Extracts of Globularia alypum L. were evaluated for their antibacterial activity with the diffusion and broth dilution methods; for antibiofilm activity, the crystal violet assay was used. The identification and the quantification of the different constituents of extracts were determined by reverse-phase high-performance liquid chromatography (RP-HPLC). Bacterial growth was found in three patients (5.1%). Enterococcus faecalis (1.7%), Acinetobacter baumanii (1.7%), and Pseudomonas putida (1.7%) strains were more commonly detected. They were resistant to several common antibiotics. All extracts presented several components, mainly nepetin-7-glucoside and trans-ferulic-acid, and they had antibacterial activity (MIC = 6.25 mg/mL and MBC = 6.25 mg/mL), and antibiofilm (59.70% at 25 mg/mL) properties, especially against Acinetobacter baumanii. The results achieved confirm the important role of this plant as a source of therapeutic activities.
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Affiliation(s)
| | - Manel Marzouk
- Laboratory of Microbiology, Hospital Farhat Hached, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia; (M.M.); (J.B.)
| | - Sahar Nouir
- Laboratory of Biochemistry, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia;
| | - Rim Ghammem
- Department of Epidemiology and Preventive Medicine, University of Sousse, Sousse 4002, Tunisia;
| | - Wissal Sahtout
- Nephrology Department, Sahloul Hospital, Sousse 4054, Tunisia;
| | - Meriam Ghardallou
- Department of Community Medicine, Research Laboratory LR12ES03, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia;
| | - Neila Fathallah
- Department of Clinical Pharmacology, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia; (N.F.); (R.S.)
| | - Jalel Boukadida
- Laboratory of Microbiology, Hospital Farhat Hached, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia; (M.M.); (J.B.)
| | - Mehdi Jaidane
- Urology Department, Sahloul Hospital, Sousse 4054, Tunisia; (K.B.); (M.J.)
| | - Raoudha Slim
- Department of Clinical Pharmacology, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia; (N.F.); (R.S.)
| | - Amira Zaïri
- Laboratory of Biochemistry, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia;
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