A prospective interventional study to examine the effect of a silver alloy and hydrogel--coated catheter on the incidence of catheter-associated urinary tract infection

Chung, Patrick HY; Wong, Charlotte; Lai, Christopher; Siu, HK; Tsang, Dnc; Yeung, KY; Ip, Dennis K. M.; Tam, Paul K. H.

doi:10.12809/hkmj164906

Cited by 21 publications

(25 citation statements)

References 12 publications

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“…In our study, no adverse reactions were registered that could be related to the NbMC ETT coating. Urinary catheters containing this coating have shown reduced catheter-related urinary tract infections with long-term use [41][42][43]. However, it should be noted that NbMC urinary catheters are made of silicone or latex, not PVC like the NbMC ETT in our study.…”

Section: Discussionmentioning

confidence: 84%

Biofilm formation on three different endotracheal tubes: A prospective clinical trial

Thorarinsdottir¹,

Kander²,

Holmberg³

et al. 2020

Preprint

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Abstract Background: Biofilm formation on endotracheal tubes (ETTs) is an early and frequent event in mechanically ventilated patients. The biofilm is believed to act as a reservoir for infecting microorganisms and thereby contribute to development and relapses of ventilator-associated pneumonia (VAP). Once a biofilm has formed on an ETT surface, it is difficult to eradicate. This clinical study aimed to compare biofilm formation on three widely used ETTs with different surface properties and to explore factors potentially predictive of biofilm formation.Methods: We compared the grade of biofilm formation on ETTs made of uncoated polyvinyl chloride (PVC), silicone-coated PVC, and PVC coated with noble metals after > 24 hours of mechanical ventilation in critically ill patients. The comparison was based on scanning electron microscopy of ETT surfaces, biofilm grading, surveillance and biofilm cultures, and occurrence of VAP.Results: High-grade (score ≥ 7) biofilm formation on the ETTs was associated with development of VAP (OR 4.17 [95% CI 1.14–15.3], p = 0.031). Compared to uncoated PVC ETTs, the silicone-coated and noble-metal-coated PVC ETTs were independently associated with reduced high-grade biofilm formation (OR 0.18 [95% CI 0.06–0.59], p = 0.005, and OR 0.34 [95% CI 0.13–0.93], p = 0.036, respectively). No significant difference was observed between silicon-coated ETTs and noble-metal-coated ETTs (OR 0.54 [95% CI 0.17–1.65], p = 0.278). In 60% of the oropharyngeal cultures and 58% of the endotracheal cultures collected at intubation, the same microorganism was found in the ETT biofilm at extubation. In patients who developed VAP, the causative microbe remained in the biofilm in 56% of cases, despite appropriate antibiotic therapy. High-grade biofilm formation on ETTs was not predicted by either colonization with common VAP pathogens in surveillance cultures or duration of invasive ventilation.Conclusion: High-grade biofilm formation on ETTs was associated with development of VAP. Compared to the uncoated PVC ETTs, the silicone-coated and noble-metal-coated PVC ETTs were independently associated with reduced high-grade biofilm formation. Further research on methods to prevent, monitor, and manage biofilm occurrence is needed.Trial registration: ClinicalTrials.gov, NCT02284438. Retrospectively registered on 21 October 2014, URL: https://clinicaltrials.gov/ct2/show/NCT02284438.

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Section: Discussionmentioning

confidence: 84%

Biofilm formation on three different endotracheal tubes: A prospective clinical trial

Thorarinsdottir¹,

Kander²,

Holmberg³

et al. 2020

Preprint

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“…Silver ions are the most popular clinically tested and available coating for urinary catheters yet the effectiveness of them is still debatable due to vast differences in outcomes in vitro, in animal models and in clinical trials studies [34,51,[72][73][74][75][76][77][78][79][80][81][82][83][84][85][86]. The mechanisms by which silver is toxic to bacteria include disruption of the membrane, proteins, and by inducing oxidative stress through the release of silver ions into the bladder [15].…”

Section: Silver Ionsmentioning

confidence: 99%

“…For example, a clinical trial of over 27,000 patients comparing silver-alloy hydrogel-coated catheters vs. siliconized latex catheters, found that the silver-alloy hydrogel-coated catheters decreased the risk of infection by 32% and was estimated to save the hospital between $14,000 and $500,000 [78]. Another clinical trial showed that silver alloy hydrogel reduced 31% the incidence of CAUTIs when compared with uncoated latex catheter [73]. Lastly, Lederer and collaborators compared silver-alloy hydrogel catheters with the hospitals' standard catheter, finding that silver-alloy hydrogel catheters reduced the incidence of CAUTI to 58% or 47%, depending on the CAUTI definition given by the National Healthcare Safety Network (NHSN) or specified clinical criteria, respectively [80].…”

Section: Clinical Studiesmentioning

confidence: 99%

Urinary Catheter Coating Modifications: The Race against Catheter-Associated Infections

Andersen

Flores-Mireles

2019

Coatings

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Urinary catheters are common medical devices, whose main function is to drain the bladder. Although they improve patients' quality of life, catheter placement predisposes the patient to develop a catheter-associated urinary tract infection (CAUTI). The catheter is used by pathogens as a platform for colonization and biofilm formation, leading to bacteriuria and increasing the risk of developing secondary bloodstream infections. In an effort to prevent microbial colonization, several catheter modifications have been made ranging from introduction of antimicrobial compounds to antifouling coatings. In this review, we discuss the effectiveness of different coatings in preventing catheter colonization in vitro and in vivo, the challenges in fighting CAUTIs, and novel approaches targeting host-catheter-microbe interactions.

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“…As a result, the use of a silver alloy hydrogel urinary catheter reduced symptomatic CAUTI occurrences according to both NHSN and clinical criteria. Chung et al examined the effect of silver and hydrogel‐coated catheter on the incidence of CAUTI . Silver alloy and hydrogel‐coated catheters appeared to be effective in preventing CAUTI.…”

Section: Antimicrobial Strategies For Urinary Cathetersmentioning

confidence: 99%

“…Chung et al examined the effect of silver and hydrogel-coated catheter on the incidence of CAUTI. 96 Silver alloy and hydrogel-coated catheters appeared to be effective in preventing CAUTI. Nevertheless, Kazmiersak et al discovered that the hydrogel layer can increase aggregation of the planktonic cells and newly nucleated crystals, leading to even faster catheter blockage than in the case of uncoated silicone.…”

Section: Antifouling Coatingsmentioning

confidence: 99%

Antimicrobial strategies for urinary catheters

Zhu

Wang

et al. 2018

J Biomedical Materials Res

110

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Over 75% of hospital‐acquired or nosocomial urinary tract infections are initiated by urinary catheters, which are used during the treatment of 16% of hospitalized patients. Taking the United States as an example, the costs of catheter‐associated urinary tract infections (CAUTI) are in excess of $451 million dollars/year. The biofilm formation by pathogenic microbes that protects pathogens from host immune defense and antimicrobial agents is the leading cause for CAUTI. Thus, tremendous efforts have been devoted to antimicrobial coating for urinary catheters in the past few decades, and it has been demonstrated to be one of the most direct and efficient strategies to reduce infections. In this article, we briefly summarize the current methods for preparation of antimicrobial coatings based on different stages in the biofilm formation, highlight recent progress in the urinary catheter coating material design and selection, discuss approaches to improving their long‐term antimicrobial efficacy, biocompatibility, multidrug resistance and recurrent infections, and finally outline future requirements and prospects in antimicrobial coating material design. The scope of the works surveyed is confined to antimicrobial urinary catheters. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 445–467, 2019.

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A prospective interventional study to examine the effect of a silver alloy and hydrogel--coated catheter on the incidence of catheter-associated urinary tract infection

Cited by 21 publications

References 12 publications

Biofilm formation on three different endotracheal tubes: A prospective clinical trial

Biofilm formation on three different endotracheal tubes: A prospective clinical trial

Urinary Catheter Coating Modifications: The Race against Catheter-Associated Infections

Antimicrobial strategies for urinary catheters

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