Biomaterial modification of urinary catheters with antimicrobials to give long-term broadspectrum antibiofilm activity

Abstract

Catheter-associated urinary tract infection (CAUTI) is the commonest hospital-acquired infection, accounting for over 100,000 hospital admissions within the USA annually. Biomaterials and processes intended to reduce the risk of bacterial colonization of the catheters for long-term users have not been successful, mainly because of the need for long duration of activity in flow conditions. Here we report the results of impregnation of urinary catheters with a combination of rifampicin, sparfloxacin and triclosan. In flow experiments, the antimicrobial catheters were able to prevent colonization by common uropathogens Proteus mirabilis, Staphylococcus aureus and Escherichia coli for 7 to 12weeks in vitro compared with 1-3days for other, commercially available antimicrobial catheters currently used clinically. Resistance development was minimized by careful choice of antimicrobial combinations. Drug release profiles and distribution in the polymer, and surface analysis were also carried out and the process had no deleterious effect on the mechanical performance of the catheter or its balloon. The antimicrobial catheter therefore offers for the first time a means of reducing infection and its complications in long-term urinary catheter users.

The potential of photo-deposited silver coatings on Foley catheters to prevent urinary tract infections

“…Catheterisation is one of the most common modern medical procedures, where the insertion of a urinary catheter bypasses the normal host defences facilitating the entry of pathogens into the bladder [2]. The bacterial pathogens most commonly associated with catheter-associated urinary tract infections (CAUTIs) are Escherichia coli and Proteus mirabilis [4]. An infection associated with Proteus mirabilis frequently leads to blockage of catheters because of biomineralisation and formation of a crystalline biofilm through the bioconversion of urinary ammonium and other salts, causing obstruction of catheter lumen and kidney infection and septicaemia [4][5][6].…”

“…The bacterial pathogens most commonly associated with catheter-associated urinary tract infections (CAUTIs) are Escherichia coli and Proteus mirabilis [4]. An infection associated with Proteus mirabilis frequently leads to blockage of catheters because of biomineralisation and formation of a crystalline biofilm through the bioconversion of urinary ammonium and other salts, causing obstruction of catheter lumen and kidney infection and septicaemia [4][5][6]. Klebsiella pneumoniae is a gastro-intestinal bacterium and an opportunistic pathogen associated with septicaemia, pneumonia, urinary tract infections, and meningitis, and can persist within the urinary tract despite appropriate antibiotic treatments [7].…”

“…Colonisation by Pseudomonas aeruginosa and Candida spp. may also be observed in patients undergoing prolonged catheterizations [4]. After longterm use, monobacterial biofilm formation has been observed to occur, some-times with multi-drug resistant organisms, on many urinary devices [8].…”

“…Progress and implementation in infection control programs are necessary and require technical advances in catheter materials for prevention of biofilm formation [18]. A variety of strategies, such as the replacement of contaminated catheters, novel materials for catheter production and surface functionalization with antibacterial agents have been suggested [4,15], including rifampicin, sparfloxacin and triclosan have been proposed for impregnation of urinary catheters [4]. Currently, the use of silver in biomedical field is increasing because of its broadspectrum antimicrobial activity demonstrated against multi-drug resistant bacteria, fungi and viruses [19,20].…”

Azithromycin-Ciprofloxacin-Impregnated Urinary Catheters Avert Bacterial Colonization, Biofilm Formation, and Inflammation in a Murine Model of Foreign-Body-Associated Urinary Tract Infections Caused by Pseudomonas aeruginosa

“…The management of these infections becomes difficult, especially when an opportunistic and drug-resistant pathogen like Pseudomonas aeruginosa is the etiological agent. P. aeruginosa and Candida species are pathogens frequently isolated from long-term-catheterized patients subjected to repeated dosage of antibiotics (6). In a recent study conducted in India, CAUTIs were reported to be the second most frequently detected infection in health care settings and P. aeruginosa as the single most causative organism of HAI (7).…”