Foley Catheter with Peri-Urethral Antimicrobial Irrigation for the Prevention of Catheter Associated Urinary Tract Infections – Assessment in an In Vitro Model

Abstract

BackgroundCatheter associated urinary tract infections (CAUTIs) are a significant medical issue with substantial morbidities and costs. CAUTIs are primarily caused by colonization of the external surface of Foley catheters which serve as conduits for colonizing microbes to access the bladder. In order to prevent these CAUTIs, we developed a double-cuff Foley catheter with a novel irrigation cuff for daily irrigation of the periurethral space with a biocompatible antimicrobial disinfecting solution. This study assessed the efficacy of this system for reducing external-surface microbial colonization of catheters in an in vitro model.MethodsThe novel double cuff Foley and disinfectant solutions were evaluated in an established in vitro CAUTI model (Gaonkar, et al 2003) where a Foley catheter indwelled in a simulated urethra. 5.5 × 105 CFU of common uropathogens (MRSA, E. coli, C. albicans) were allowed to attach to the external catheter surface at meatal end of the catheter for 2 hours at 37°C. Subsequently, 3 mL of disinfectant solutions were instilled through the irrigation cuff and covered the periurethral catheter surfaces. Catheters were then incubated an additional 24–48 hours at 37°C, removed, cut into segments, and adherent organisms were quantified by sonication. Disinfectant solutions evaluated included various combinations of 1% polygalacturonic acid (PG), 0.4% caprylic acid (CAP) and (dilute) 0.3% H2O2.ResultsFor all organisms tested only the triple combination periurtehral flush (PG+CAP+H2O2) completely prevented biofilm colonization of catheters indicating antimicrobial synergy of the component agents. Control catheters grew >104 CFU/segment. Single agent or double agents combinations were only partially effective in preventing colonization by all three pathogens.ConclusionThe PG + CAP + H2O2 periurethral disinfectant flush instilled through an irrigation cuff in a novel double-cuff Foley catheter was able to completely prevent microbial colonization of the external catheter surface by MRSA, E. coli and C. albicans in an in vitro CAUTI model. In vivo studies are needed to further evaluate this technology for prevention of CAUTI.Disclosures J. Rosenblatt, Infective Technologies, LLC: Co-Inventor of the Nitroglycerin-Citrate-Ethanol catheter lock solution technology which is owned by the University of Texas MD Anderson Cancer Center (UTMDACC) and has been licensed by Novel Anti-Infective Technologies, LLC in which Dr. Rosenblatt is a and Shareholder, Licensing agreement or royalty; UT MD Anderson Cancer Center: Co-Inventor of the Nitroglycerin-Citrate-Ethanol catheter lock solution technology which is owned by the University of Texas MD Anderson Cancer Center (UTMDACC) and has been licensed by Novel Anti-Infective Technologies, LLC in which Dr. Rosenblatt is a s and Scientific Advisor, Licensing agreement or royalty; I. Raad, Merck: Grant Investigator, Research grant; Allergan: Grant Investigator, Research grant; Infective Technologies, LLC: Co-Inventor of the Nitroglycerin-Citrate-Ethanol cathet...

Review of Catheter-Associated Urinary Tract Infections and In Vitro Urinary Tract Models

“…Essentially, four models of the urinary tract or sections of the urinary tract and their adaptations have been developed in an attempt to more closely represent the anatomy and conditions in situ [ 28 , 44 – 46 ]. These models are the bladder model by Stickler et al [ 86 ], the urinary tract model by Gaonkar et al [ 2 ], the CAUTI model by Rosenblatt et al [ 87 ], and the meatus model by Holland and Fish [ 39 ].…”

“…Recently, the Gaonkar et al [ 2 ] model has been adapted by Rosenblatt et al [ 90 ]. Communicated on a poster presented in October 2017 at the IDweek conference in San Diego, California, Rosenblatt et al [ 87 ] revealed their modified version of the urinary tract model or CAUTI model ( Figure 6 ). This model consists of only one tube with an upper bulbous end to allow inflation of the retention cuff and a cap at the other end.…”

Pathogen displacement during intermittent catheter insertion: a novel in vitro urethra model

“…Numerous studies have been carried out to test new catheter materials, antimicrobials, natural compounds, alternative catheter designs, probiotics and patient care regimes in an effort to reduce or prevent CAUTIs related to indwelling catheters with varying levels of success (Hull et al 2000;Hentzer et al 2002;Stickler et al 2002;Brosnahan et al 2004;Mathur et al 2006;Stickler 2014;Levering et al 2016;Cortese et al 2018). There are several in vitro models to test the efficacy of indwelling catheters to prevent either biofilm formation, encrustation or CAUTI development (Stickler et al 1987;King et al 1992;Morris et al 1997;Stickler et al 1999;Gaonkar et al 2003;Barford et al 2008;Williams and Stickler 2008;Coenye and Nelis 2010;Jordan et al 2015;Chua et al 2017;Rosenblatt et al 2017;Cortese et al 2018). There are two main anatomical in vitro models that have been developed to test indwelling catheters, that is, the bladder model described by Stickler et al (1999Stickler et al ( , 1987 and the urinary tract model developed by Gaonkar et al (2003).…”

“…There are two main anatomical in vitro models that have been developed to test indwelling catheters, that is, the bladder model described by Stickler et al (1999Stickler et al ( , 1987 and the urinary tract model developed by Gaonkar et al (2003). Both of these models have been adapted and inspired a multitude of derivative models that have aided in the advancement of indwelling catheter design and CAUTI management (King et al 1992;Morris et al 1997;Barford et al 2008;Williams and Stickler 2008;Jordan et al 2015;Chua et al 2017;Rosenblatt et al 2017).…”

Antibiofilm properties of triclosan with EDTA or cranberry as Foley Catheter lock solutions

“…Different Foley catheter lock solutions were previously tested, for example ethanol, minocycline alone or in combination with EDTA (Raad et al ) and N‐acetylcysteine (Marchese et al ). Recently, due to the emergence of resistant micro‐organisms to commonly used antibiotics, nonantibiotic antimicrobials and alternative methods to antimicrobial treatments are gaining popularity as promising methods to control infections (Rosenblatt et al ; Noeltinget et al ; Sihra et al ).…”