Evaluation of the Antimicrobial Efficacy of Urinary Catheters Impregnated With Antiseptics in an In Vitro Urinary Tract Model

Gaonkar, Trupti A.; Sampath, Lester; Modak, Shanta

doi:10.1086/502241

Cited by 71 publications

(75 citation statements)

References 35 publications

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“…Likewise, after extended incubation in saline, although neither antimicrobial-coated catheter significantly inhibited the test organisms overall, some organism-specific inhibition was apparent, especially with the nitrofurazone-coated catheter. These findings confirm and extend previous in vitro assessments of these two antimicrobial catheters (4,8,11,12).…”

supporting

confidence: 90%

“…Notably, in one clinical trial the nitrofurazone-coated catheter reduced bacteriuria risk over the first week of use (14). Additionally, in an artificial bladder model, this catheter prevented bacterial ingress during daily "meatal" challenge for up to 21 days, versus only 1.2 days for the silver alloy-coated catheter (8). These findings suggest that the rapidly declining activity we observed in vitro may not apply in vivo.…”

mentioning

confidence: 81%

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In Vitro Comparison of Nitrofurazone- and Silver Alloy-Coated Foley Catheters for Contact-Dependent and Diffusible Inhibition of Urinary Tract Infection-Associated Microorganisms

Johnson

Johnston

Kuskowski

2012

Antimicrob Agents Chemother

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Two marketed antimicrobial-coated Foley catheters were compared for in vitro diffusible and contact-dependent inhibition of 11 urinary tract infection-associated microorganisms in an adherence-biofilm assay. Nitrofurazone-coated catheters significantly outperformed silver alloy-coated catheters for inhibitory activity, according to both inoculum broth and catheter sonicate counts, whether compared directly or against the corresponding control catheters. Although inhibition waned with catheter preincubation in saline, some organisms were inhibited even after a 48-h catheter preincubation, especially by the nitrofurazonecoated catheter. Foley catheters unfortunately promote microbial colonization of the urinary tract (17,20). Although such colonization is usually asymptomatic, it can lead to symptomatic urinary tract infection (UTI), increased costs, prolonged hospital stays, and a reservoir of resistant microorganisms (17). It also triggers unnecessary antimicrobial use, with attendant costs and harms (3). Therefore, prevention of catheter-associated bacteriuria/funguria is important for improving patient safety and reducing health care costs (9,15,18).Antimicrobial-coated Foley catheters are intended to lower the risk of catheter-associated bacteriuria/funguria (5, 9, 13). The available devices use as antimicrobial coatings nitrofurazone (a nitrofurantoin congener) or various silver compounds. Clinical trials have documented short-term efficacies for both catheter types against bacteriuria/funguria, with the nitrofurazone catheter appearing more efficacious (versus control) in recent studies (5, 13). However, no published trial has directly compared different antimicrobial-coated catheters.We showed previously, using an agar plate-based assay, that the nitrofurazone-coated catheter inhibits many UTI-associated microorganisms (10) and that against certain multidrug-resistant variants its effect is more potent and durable than a silver alloycoated catheter's (11). Subsequently, using a novel biofilm-based assay, we documented superiority for the nitrofurazone-coated catheter over two silver alloy-coated catheters, specifically against cephalosporin-resistant Escherichia coli (12). Here, we used this biofilm-based assay to compare nitrofurazone and silver alloycoated catheters against a broader array of urine organisms.Isolates. Eleven urine isolates were obtained from the VA Medical Center Clinical Microbiology Laboratory; these isolates represented the 11 species stipulated by the U.S. Food and Drug Administration as relevant for testing of antimicrobial urological devices (http://www.fda.gov/MedicalDevices/DeviceRegulationand Guidance/GuidanceDocuments/ucm080884.htm; last updated 6/18/2009; last accessed 2/12/2012). These included 6 Gram-negative species, i.e., Citrobacter koseri (formerly C. diversus), Enterobacter Nitrofurantoin and silver susceptibility. Nitrofurantoin susceptibility was assessed by disk diffusion, using the conditions and interpretive criteria specified by the Clinical and Laboratory Stand...

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supporting

confidence: 90%

mentioning

confidence: 81%

In Vitro Comparison of Nitrofurazone- and Silver Alloy-Coated Foley Catheters for Contact-Dependent and Diffusible Inhibition of Urinary Tract Infection-Associated Microorganisms

Johnson

Johnston

Kuskowski

2012

Antimicrob Agents Chemother

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“…Catheters impregnated with synergistic combinations of chlorhexidine, silver sulfadiazine, and triclosan prevented the adherence of a broad spectrum of extraluminal bacteria on their outer surfaces compared to silver hydrogel latex-and nitrofurazone-treated silicone catheters in an in vitro urinary tract model (105).…”

Section: Catheters Containing Antimicrobial Agentsmentioning

confidence: 93%

Complicated Catheter-Associated Urinary Tract Infections Due toEscherichia coliandProteus mirabilis

et al. 2008

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SUMMARY Catheter-associated urinary tract infections (CAUTIs) represent the most common type of nosocomial infection and are a major health concern due to the complications and frequent recurrence. These infections are often caused by Escherichia coli and Proteus mirabilis. Gram-negative bacterial species that cause CAUTIs express a number of virulence factors associated with adhesion, motility, biofilm formation, immunoavoidance, and nutrient acquisition as well as factors that cause damage to the host. These infections can be reduced by limiting catheter usage and ensuring that health care professionals correctly use closed-system Foley catheters. A number of novel approaches such as condom and suprapubic catheters, intermittent catheterization, new surfaces, catheters with antimicrobial agents, and probiotics have thus far met with limited success. While the diagnosis of symptomatic versus asymptomatic CAUTIs may be a contentious issue, it is generally agreed that once a catheterized patient is believed to have a symptomatic urinary tract infection, the catheter is removed if possible due to the high rate of relapse. Research focusing on the pathogenesis of CAUTIs will lead to a better understanding of the disease process and will subsequently lead to the development of new diagnosis, prevention, and treatment options.

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“…They are widely deployed throughout health care (4-6), domestic (7,8), and industrial (9)(10)(11) environments, where their application includes antisepsis (12), hard surface disinfection (13), and pharmaceutical product preservation (14). They may also be incorporated into medical device coatings, for instance in sutures (15), wound dressings (16), and urinary catheters (17) to inhibit bacterial adhesion and subsequent biofilm formation.…”

mentioning

confidence: 99%

Effects of Formulation on Microbicide Potency and Mitigation of the Development of Bacterial Insusceptibility

Cowley

Forbes

Amézquita

et al. 2015

Appl Environ Microbiol

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bRisk assessments of the potential for microbicides to select for reduced bacterial susceptibility have been based largely on data generated through the exposure of bacteria to microbicides in aqueous solution. Since microbicides are normally formulated with multiple excipients, we have investigated the effect of formulation on antimicrobial activity and the induction of bacterial insusceptibility. We tested 8 species of bacteria (7 genera) before and after repeated exposure (14 passages), using a previously validated gradient plating system, for their susceptibilities to the microbicides benzalkonium chloride, benzisothiozolinone, chlorhexidine, didecyldimethyl ammonium chloride, DMDM-hydantoin, polyhexamethylene biguanide, thymol, and triclosan in aqueous solution (nonformulated) and in formulation with excipients often deployed in consumer products. Susceptibilities were also assessed following an additional 14 passages without microbicide to determine the stability of any susceptibility changes. MICs and minimum bactericidal concentrations (MBC) were on average 11-fold lower for formulated microbicides than for nonformulated microbicides. After exposure to the antimicrobial compounds, of 72 combinations of microbicide and bacterium there were 19 >4-fold (mean, 8-fold) increases in MIC for nonformulated and 8 >4-fold (mean, 2-fold) increases in MIC for formulated microbicides. Furthermore, there were 20 >4-fold increases in MBC (mean, 8-fold) for nonformulated and 10 >4-fold (mean, 2-fold) increases in MBC for formulated microbicides. Susceptibility decreases fully or partially reverted back to preexposure values for 49% of MICs and 72% of MBCs after further passage. In summary, formulated microbicides exhibited greater antibacterial potency than unformulated actives and susceptibility decreases after repeated exposure were lower in frequency and extent. Microbicides are broad-spectrum chemical agents that inactivate microorganisms (1-3). They are widely deployed throughout health care (4-6), domestic (7,8), and industrial (9-11) environments, where their application includes antisepsis (12), hard surface disinfection (13), and pharmaceutical product preservation (14). They may also be incorporated into medical device coatings, for instance in sutures (15), wound dressings (16), and urinary catheters (17) to inhibit bacterial adhesion and subsequent biofilm formation.It has been hypothesized that the use of microbicides could select for bacterial adaptation, resulting in reduced efficacy of the primary agent, as well as potentially decreasing bacterial susceptibility to chemically unrelated agents such as other microbicides and antibiotics (18). While there have been reports documenting the laboratory selection of bacteria with decreased microbicide sensitivity following repeated exposure to microbicides in highly selective conditions, it remains unclear whether this commonly occurs in the environment (19-24).The majority of studies reporting reductions in microbicide susceptibility have used the active compo...

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Evaluation of the Antimicrobial Efficacy of Urinary Catheters Impregnated With Antiseptics in an In Vitro Urinary Tract Model

Abstract: Catheters impregnated with synergistic combinations of chlorhexidine, silver sulfadiazine, and triclosan exhibited broad-spectrum, long-term resistance against microbial colonization on their outer surfaces.

Cited by 71 publications

References 35 publications

In Vitro Comparison of Nitrofurazone- and Silver Alloy-Coated Foley Catheters for Contact-Dependent and Diffusible Inhibition of Urinary Tract Infection-Associated Microorganisms

In Vitro Comparison of Nitrofurazone- and Silver Alloy-Coated Foley Catheters for Contact-Dependent and Diffusible Inhibition of Urinary Tract Infection-Associated Microorganisms

Complicated Catheter-Associated Urinary Tract Infections Due toEscherichia coliandProteus mirabilis

Effects of Formulation on Microbicide Potency and Mitigation of the Development of Bacterial Insusceptibility

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