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Herout R, Khoddami S, Moskalev I, Reicherz A, Chew BH, Armbruster CE, Lange D. Role of Bacterial Surface Components in the Pathogenicity of Proteus mirabilis in a Murine Model of Catheter-Associated Urinary Tract Infection. Pathogens 2023; 12:pathogens12040509. [PMID: 37111395 PMCID: PMC10143806 DOI: 10.3390/pathogens12040509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Proteus mirabilis (PM) is a Gram-negative, rod-shaped bacterium that causes catheter-associated urinary tract infections (CAUTIs). The specific roles of bacterial surface components (BSCs) in PM pathogenicity and CAUTIs remain unknown. To address this knowledge gap, we utilized relevant in vitro adhesion/invasion models and a well-established murine model of CAUTI to assess the ability of wildtype (WT) and seven mutant strains (MSs) of PM with deficiencies in various genes encoding BSCs to undergo the infectious process (including adhesion to catheters) in both model systems. Overall, MSs adhesion to catheters and the different cell types tested was significantly reduced compared to WT, while no invasion of cells was evident at 24 h. In vivo, WT showed a greater number of planktonic (urine) bacteria, bacteria adherent to catheters, and bacteria adherent to/invading bladder tissue when compared to the MSs. Bacterial counts in urine for PMI3191 and waaE mutants were lower than that for WT and other MSs. The complementation of mutated BSC genes resulting in the biggest defects restored the invasion phenotype both in vitro and in vivo. BSCs play a critical role at various steps in the pathogenicity of PM including adhesion to indwelling medical devices and adhesion/invasion of urinary tissue in vivo.
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Affiliation(s)
- Roman Herout
- The Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01062 Dresden, Germany
| | - Sara Khoddami
- The Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada
| | - Igor Moskalev
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada
| | - Alina Reicherz
- The Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada
- Department of Urology, Marien Hospital Herne, Ruhr-University of Bochum, 44649 Herne, Germany
| | - Ben H Chew
- The Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada
| | - Chelsie E Armbruster
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14263, USA
| | - Dirk Lange
- The Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada
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2
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Yazdani-Ahmadabadi H, Yu K, Khoddami S, F. Felix D, Yeh HH, Luo HD, Moskalev I, Wang Q, Wang R, Grecov D, Fazli L, Lange D, Kizhakkedathu JN. Robust Nanoparticle-Derived Lubricious Antibiofilm Coating for Difficult-to-Coat Medical Devices with Intricate Geometry. ACS Nanosci Au 2023; 3:67-83. [PMID: 36820095 PMCID: PMC9936578 DOI: 10.1021/acsnanoscienceau.2c00040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 06/18/2023]
Abstract
A major medical device-associated complication is the biofilm-related infection post-implantation. One promising approach to prevent this is to coat already commercialized medical devices with effective antibiofilm materials. However, developing a robust high-performance antibiofilm coating on devices with a nonflat geometry remains unmet. Here, we report the development of a facile scalable nanoparticle-based antibiofilm silver composite coating with long-term activity applicable to virtually any objects including difficult-to-coat commercially available medical devices utilizing a catecholic organic-aqueous mixture. Using a screening approach, we have identified a combination of the organic-aqueous buffer mixture which alters polycatecholamine synthesis, nanoparticle formation, and stabilization, resulting in controlled deposition of in situ formed composite silver nanoparticles in the presence of an ultra-high-molecular-weight hydrophilic polymer on diverse objects irrespective of its geometry and chemistry. Methanol-mediated synthesis of polymer-silver composite nanoparticles resulted in a biocompatible lubricious coating with high mechanical durability, long-term silver release (∼90 days), complete inhibition of bacterial adhesion, and excellent killing activity against a diverse range of bacteria over the long term. Coated catheters retained their excellent activity even after exposure to harsh mechanical challenges (rubbing, twisting, and stretching) and storage conditions (>3 months stirring in water). We confirmed its excellent bacteria-killing efficacy (>99.999%) against difficult-to-kill bacteria (Proteus mirabilis) and high biocompatibility using percutaneous catheter infection mice and subcutaneous implant rat models, respectively, in vivo. The developed coating approach opens a new avenue to transform clinically used medical devices (e.g., urinary catheters) to highly infection-resistant devices to prevent and treat implant/device-associated infections.
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Affiliation(s)
- Hossein Yazdani-Ahmadabadi
- Department
of Chemistry, University of British Columbia, Vancouver V6T 1Z3, British Columbia, Canada
- Centre
for Blood Research, Life Science Institute, University of British Columbia, Vancouver V6T 1Z3, British
Columbia, Canada
| | - Kai Yu
- Centre
for Blood Research, Life Science Institute, University of British Columbia, Vancouver V6T 1Z3, British
Columbia, Canada
- Department
of Pathology and Laboratory Medicine, University
of British Columbia, Vancouver V6T 1Z7, British Columbia, Canada
| | - Sara Khoddami
- Department
of Urologic Sciences, University of British
Columbia, Vancouver V6H 3Z6, British Columbia, Canada
- The
Stone Centre at Vancouver General Hospital, Vancouver V5Z 1M9, British Columbia, Canada
| | - Demian F. Felix
- Department
of Urologic Sciences, University of British
Columbia, Vancouver V6H 3Z6, British Columbia, Canada
- The
Stone Centre at Vancouver General Hospital, Vancouver V5Z 1M9, British Columbia, Canada
| | - Han H. Yeh
- Department
of Mechanical Engineering, University of
British Columbia, Vancouver V6T 1Z4, British Columbia, Canada
| | - Haiming D. Luo
- Department
of Chemistry, University of British Columbia, Vancouver V6T 1Z3, British Columbia, Canada
- Centre
for Blood Research, Life Science Institute, University of British Columbia, Vancouver V6T 1Z3, British
Columbia, Canada
| | - Igor Moskalev
- Vancouver
Prostate Centre, University of British Columbia, Vancouver V6H 3Z6, British Columbia, Canada
| | - Qiong Wang
- Department
of Materials Engineering, University of
British Columbia, Vancouver V6T 1Z4, British Columbia, Canada
| | - Rizhi Wang
- Department
of Materials Engineering, University of
British Columbia, Vancouver V6T 1Z4, British Columbia, Canada
- School
of Biomedical Engineering, University of
British Columbia, Vancouver V6T 1Z3, British Columbia, Canada
| | - Dana Grecov
- Department
of Mechanical Engineering, University of
British Columbia, Vancouver V6T 1Z4, British Columbia, Canada
| | - Ladan Fazli
- Vancouver
Prostate Centre, University of British Columbia, Vancouver V6H 3Z6, British Columbia, Canada
| | - Dirk Lange
- Department
of Urologic Sciences, University of British
Columbia, Vancouver V6H 3Z6, British Columbia, Canada
- The
Stone Centre at Vancouver General Hospital, Vancouver V5Z 1M9, British Columbia, Canada
| | - Jayachandran N. Kizhakkedathu
- Department
of Chemistry, University of British Columbia, Vancouver V6T 1Z3, British Columbia, Canada
- Centre
for Blood Research, Life Science Institute, University of British Columbia, Vancouver V6T 1Z3, British
Columbia, Canada
- Department
of Pathology and Laboratory Medicine, University
of British Columbia, Vancouver V6T 1Z7, British Columbia, Canada
- School
of Biomedical Engineering, University of
British Columbia, Vancouver V6T 1Z3, British Columbia, Canada
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3
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Yazdani-Ahmadabadi H, Felix DF, Yu K, Yeh HH, Luo HD, Khoddami S, Takeuchi LE, Alzahrani A, Abbina S, Mei Y, Fazli L, Grecov D, Lange D, Kizhakkedathu JN. Durable Surfaces from Film-Forming Silver Assemblies for Long-Term Zero Bacterial Adhesion without Toxicity. ACS Cent Sci 2022; 8:546-561. [PMID: 35647287 PMCID: PMC9136974 DOI: 10.1021/acscentsci.1c01556] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Indexed: 06/15/2023]
Abstract
The long-term prevention of biofilm formation on the surface of indwelling medical devices remains a challenge. Silver has been reutilized in recent years for combating biofilm formation due to its indisputable bactericidal potency; however, the toxicity, low stability, and short-term activity of the current silver coatings have limited their use. Here, we report the development of silver-based film-forming antibacterial engineered (SAFE) assemblies for the generation of durable lubricous antibiofilm surface long-term activity without silver toxicity that was applicable to diverse materials via a highly scalable dip/spray/solution-skinning process. The SAFE coating was obtained through a large-scale screening, resulting in effective incorporation of silver nanoparticles (∼10 nm) into a stable nonsticky coating with high surface hierarchy and coverage, which guaranteed sustained silver release. The lead coating showed zero bacterial adhesion over a 1 month experiment in the presence of a high load of diverse bacteria, including difficult-to-kill and stone-forming strains. The SAFE coating showed high biocompatibility and excellent antibiofilm activity in vivo.
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Affiliation(s)
- Hossein Yazdani-Ahmadabadi
- Department
of Chemistry, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Centre
for Blood Research, Life Science Institute, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Demian F. Felix
- The
Stone Centre at Vancouver General Hospital, Department of Urologic
Sciences, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Kai Yu
- Centre
for Blood Research, Life Science Institute, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Department
of Pathology and Laboratory Medicine, University
of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Han H. Yeh
- Department
of Mechanical Engineering, University of
British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Haiming D. Luo
- Department
of Chemistry, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Centre
for Blood Research, Life Science Institute, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Sara Khoddami
- The
Stone Centre at Vancouver General Hospital, Department of Urologic
Sciences, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Lily E. Takeuchi
- Centre
for Blood Research, Life Science Institute, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Department
of Pathology and Laboratory Medicine, University
of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Amal Alzahrani
- The
Stone Centre at Vancouver General Hospital, Department of Urologic
Sciences, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Srinivas Abbina
- Centre
for Blood Research, Life Science Institute, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Yan Mei
- Centre
for Blood Research, Life Science Institute, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Department
of Pathology and Laboratory Medicine, University
of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Ladan Fazli
- Vancouver
Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia V6H 3Z6, Canada
| | - Dana Grecov
- Department
of Mechanical Engineering, University of
British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
- The
School of Biomedical Engineering, University
of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Dirk Lange
- The
Stone Centre at Vancouver General Hospital, Department of Urologic
Sciences, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Jayachandran N. Kizhakkedathu
- Department
of Chemistry, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Centre
for Blood Research, Life Science Institute, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Department
of Pathology and Laboratory Medicine, University
of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- The
School of Biomedical Engineering, University
of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
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4
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Yu K, Alzahrani A, Khoddami S, Cheng JTJ, Mei Y, Gill A, Luo HD, Haney EF, Hilpert K, Hancock REW, Lange D, Kizhakkedathu JN. Rapid Assembly of Infection-Resistant Coatings: Screening and Identification of Antimicrobial Peptides Works in Cooperation with an Antifouling Background. ACS Appl Mater Interfaces 2021; 13:36784-36799. [PMID: 34328312 DOI: 10.1021/acsami.1c07515] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Bacterial adhesion and the succeeding biofilm formation onto surfaces are responsible for implant- and device-associated infections. Bifunctional coatings integrating both nonfouling components and antimicrobial peptides (AMPs) are a promising approach to develop potent antibiofilm coatings. However, the current approaches and chemistry for such coatings are time-consuming and dependent on substrates and involve a multistep process. Also, the information is limited on the influence of the coating structure or its components on the antibiofilm activity of such AMP-based coatings. Here, we report a new strategy to rapidly assemble a stable, potent, and substrate-independent AMP-based antibiofilm coating in a nonfouling background. The coating structure allowed for the screening of AMPs in a relevant nonfouling background to identify optimal peptide combinations that work in cooperation to generate potent antibiofilm activity. The structure of the coating was changed by altering the organization of the hydrophilic polymer chains within the coatings. The coatings were thoroughly characterized using various surface analytical techniques and correlated with the efficiency to prevent biofilm formation against diverse bacteria. The coating method that allowed the conjugation of AMPs without altering the steric protection ability of hydrophilic polymer structure results in a bifunctional surface coating with excellent antibiofilm activity. In contrast, the conjugation of AMPs directly to the hydrophilic polymer chains resulted in a surface with poor antibiofilm activity and increased adhesion of bacteria. Using this coating approach, we further established a new screening method and identified a set of potent surface-tethered AMPs with high activity. The success of this new peptide screening and coating method is demonstrated using a clinically relevant mouse infection model to prevent catheter-associated urinary tract infection (CAUTI).
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Affiliation(s)
- Kai Yu
- Centre for Blood Research and Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Amal Alzahrani
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Sara Khoddami
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - John T J Cheng
- Department of Microbiology and Immunology and Centre for Microbial Diseases and Immunity Research, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Yan Mei
- Centre for Blood Research and Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Arshdeep Gill
- Department of Chemistry, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Haiming D Luo
- Department of Chemistry, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Evan F Haney
- Department of Microbiology and Immunology and Centre for Microbial Diseases and Immunity Research, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Kai Hilpert
- Institute of Infection and Immunology, St. George's University of London (SGUL), London SW17 0RE, United Kingdom
| | - Robert E W Hancock
- Department of Microbiology and Immunology and Centre for Microbial Diseases and Immunity Research, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Dirk Lange
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Jayachandran N Kizhakkedathu
- Centre for Blood Research and Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Department of Chemistry, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- The School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
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5
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Yu K, Alzahrani A, Khoddami S, Ferreira D, Scotland KB, Cheng JTJ, Yazdani‐Ahmadabadi H, Mei Y, Gill A, Takeuchi LE, Yeung E, Grecov D, Hancock REW, Chew BH, Lange D, Kizhakkedathu JN. Self-Limiting Mussel Inspired Thin Antifouling Coating with Broad-Spectrum Resistance to Biofilm Formation to Prevent Catheter-Associated Infection in Mouse and Porcine Models. Adv Healthc Mater 2021; 10:e2001573. [PMID: 33470545 DOI: 10.1002/adhm.202001573] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/23/2020] [Indexed: 12/22/2022]
Abstract
Catheter-associated urinary tract infections (CAUTIs) are one of the most commonly occurring hospital-acquired infections. Current coating strategies to prevent catheter-associated biofilm formation are limited by their poor long-term efficiency and limited applicability to diverse materials. Here, the authors report a highly effective non-fouling coating with long-term biofilm prevention activity and is applicable to diverse catheters. The thin coating is lubricous, stable, highly uniform, and shows broad spectrum prevention of biofilm formation of nine different bacterial strains and prevents the migration of bacteria on catheter surface. The coating method is adapted to human-sized catheters (both intraluminal and extraluminal) and demonstrates long-term biofilm prevention activity over 30 days in challenging conditions. The coated catheters are tested in a mouse CAUTI model and demonstrate high efficiency in preventing bacterial colonization of both Gram-positive and Gram-negative bacteria. Furthermore, the coated human-sized Foley catheters are evaluated in a porcine CAUTI model and show consistent efficiency in reducing biofilm formation by Escherichia coli (E. coli) over 95%. The simplicity of the coating method, the ability to apply this coating on diverse materials, and the high efficiency in preventing bacterial adhesion increase the potential of this method for the development of next generation infection resistant medical devices.
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Affiliation(s)
- Kai Yu
- Centre for Blood Research and Department of Pathology & Laboratory Medicine University of British Columbia Vancouver British Columbia V6T 1Z3 Canada
| | - Amal Alzahrani
- The Stone Centre at VGH Department of Urologic Sciences University of British Columbia Vancouver British Columbia V5Z 1M9 Canada
| | - Sara Khoddami
- The Stone Centre at VGH Department of Urologic Sciences University of British Columbia Vancouver British Columbia V5Z 1M9 Canada
| | - Demian Ferreira
- The Stone Centre at VGH Department of Urologic Sciences University of British Columbia Vancouver British Columbia V5Z 1M9 Canada
| | - Kymora B. Scotland
- The Stone Centre at VGH Department of Urologic Sciences University of British Columbia Vancouver British Columbia V5Z 1M9 Canada
| | - John T. J. Cheng
- Department of Microbiology and Immunology and Centre for Microbial Diseases and Immunity Research University of British Columbia Vancouver British Columbia V6T 1Z4 Canada
| | | | - Yan Mei
- Centre for Blood Research and Department of Pathology & Laboratory Medicine University of British Columbia Vancouver British Columbia V6T 1Z3 Canada
| | - Arshdeep Gill
- Department of Chemistry University of British Columbia Vancouver British Columbia V6T 1Z3 Canada
| | - Lily E. Takeuchi
- Centre for Blood Research and Department of Pathology & Laboratory Medicine University of British Columbia Vancouver British Columbia V6T 1Z3 Canada
| | - Edbert Yeung
- Department of Mechanical Engineering University of British Columbia Vancouver British Columbia V6T 1Z3 Canada
| | - Dana Grecov
- Department of Mechanical Engineering University of British Columbia Vancouver British Columbia V6T 1Z3 Canada
| | - Robert E. W. Hancock
- Department of Microbiology and Immunology and Centre for Microbial Diseases and Immunity Research University of British Columbia Vancouver British Columbia V6T 1Z4 Canada
| | - Ben H. Chew
- The Stone Centre at VGH Department of Urologic Sciences University of British Columbia Vancouver British Columbia V5Z 1M9 Canada
| | - Dirk Lange
- The Stone Centre at VGH Department of Urologic Sciences University of British Columbia Vancouver British Columbia V5Z 1M9 Canada
| | - Jayachandran N. Kizhakkedathu
- Centre for Blood Research and Department of Pathology & Laboratory Medicine University of British Columbia Vancouver British Columbia V6T 1Z3 Canada
- Department of Chemistry University of British Columbia Vancouver British Columbia V6T 1Z3 Canada
- School of Biomedical Engineering University of British Columbia Vancouver British Columbia V6T 1Z3 Canada
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6
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Khoddami S, Chew BH, Lange D. Problems and solutions of stent biofilm and encrustations: A review of literature. Turk J Urol 2020; 46:S11-S18. [PMID: 33052843 DOI: 10.5152/tud.2020.20408] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
A ureteral stent is a commonly implanted urological device in patients with urinary tract obstruction. The main role of these stents is to allow adequate drainage of urine from the kidney into the bladder. Individuals with strictures, tumors, or obstructions from urinary stones do not have adequate urine flow and require ureteral stents as a part of their treatment to avoid potential hydronephrosis and renal failure. Although ureteral stents are highly effective in treating urinary tract obstructions, they have associated morbidities, such as biofilm formation and encrustation. Researchers have studied about how to diminish these negative outcomes by developing novel stent materials. Different coatings and biomaterials have been developed to reduce bacterial adhesion and crystal deposition onto the stent surfaces. Moreover, new investigation technologies, such as microfluidic platforms and encrustation sensors, have been utilized to better study the stents. Biofilms and encrustations can stem from bacterial origins; therefore, understanding the urinary microbiome will also provide insight into the solutions for treating them. There are still some gaps in our knowledge regarding the exact underlying mechanisms of stent-associated biofilms and encrustation. Future studies should include continuous testing of novel stent biomaterials for safety and efficacy, developing new technologies for identifying and extracting biofilms, enriching the assessment of stent encrustation, and diving deeper into understanding the urinary microbiome.
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Affiliation(s)
- Sara Khoddami
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ben H Chew
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Dirk Lange
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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