Objective
To test the resistance of currently available types of indwelling urethral catheters to blockage by encrustation with mineralized Proteus mirabilis biofilms.
Materials and methods
Encrustation was studied in a simple laboratory model of the catheterized bladder. Artificial urine was supplied to the bladder chamber at 0.5 mL/min. The bladder urine was inoculated with a clinical strain of P. mirabilis that had been isolated from an encrusted catheter. The models were operated until the catheters blocked and atomic absorption spectrometry was used to assess the amounts of calcium and magnesium deposited on the catheters. Scanning electron microscopy was also used to locate and assess the degree of encrustation.
Results
The mean times to blockage ranged from 21 h for the Bard hydrogel/silver‐coated latex catheter to 56 h for the Eschmann Folatex S all‐silicone catheter. The calcium and magnesium salts were mainly deposited on the 10 cm below the eye‐holes of the catheters, complete blockage generally occurring in the 2 cm immediately below the eye‐hole.
Conclusion
None of the 18 types of catheter tested, including those coated with hydrogel or silver, were capable of resisting encrustation by P. mirabilis biofilm.
Bacterial biofilms were observed on 69 of 75 catheters taken from patients undergoing long-term bladder management. Ten catheters were colonized by pure cultures of Proteus mirabilis. In each of these cases the bacteria formed layers on the catheter surface, underlying encrustations of struvite and hydroxyapatite which partially or completely occluded the catheter lumen. Encrustation was also apparent on catheters colonized by P. mirabilis plus other species, but was rarely seen on catheters colonized by non-urease-producing species. These observations support the hypothesis that catheter encrustation is brought about by the activity of urease-producing biofilms and confirms that the main target in the control of catheter encrustation should be P. mirabilis.
The ultrastructure of the labellar epidermis of 13 species of Maxillaria and one hybrid was examined using low‐vacuum scanning electron microscopy (SEM). The labellum may be homogeneous and glabrous or papillose, comprising one type of cell only, or heterogeneous with papillae, uniseriate trichomes and/or glands in various combinations. The trichomes are unbranched and multicellular with pointed or truncated tips. Moreover, in some taxa, moniliform trichomes occur, and these are thought to fragment with the formation of pseudopollen. Homogeneous and heterogeneous labellar organization may represent separate evolutionary lines. Preliminary results suggest that labellar features may provide additional taxonomic characters allowing determination of intrageneric affinities.
Fifty Foley bladder catheters that had been indwelling for periods ranging from 3 to 83 days (mean 35 days) were examined for the presence of bacterial biofilm. Scanning electron microscopy on freeze-dried cross-sections and fixed, critical point-dried longitudinal sections revealed biofilm formation on the luminal surfaces of 44 of the catheters. Culture of urine samples and sonicates from catheters revealed that the prevalence of bacteriuria was less than that of catheter colonization. A wide range of nosocomial species were found colonizing the catheters, Escherichia coli being most often isolated. The bacterial composition of the biofilms ranged from single species to mixed communities containing up to four species. There was no relationship between the length of time that the catheter had been in situ and the extent of biofilm formation. The biofilms varied in thickness from 3 to 490 microns and were visible as layers of bacterial cells up to about 400 cells deep, embedded in a matrix.
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