Proteus mirabilis biofilms and the encrustation of urethral catheters

Stickler, D.J.; Ganderton, L.; King, J. B.; Nettleton, J.; Winters, C.

doi:10.1007/bf00300077

Cited by 135 publications

(96 citation statements)

References 20 publications

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“…Significantly, species capable of producing the enzyme urease are predominant. 10 Urease is the catalyst that generates the crystals, hydrolyzing urea in the residual bladder urine to produce two molecules of ammonia to every molecule of carbon dioxide causing a rise in pH. As the urine becomes alkaline, crystallization of the magnesium and calcium phosphates is induced.…”

Section: Nature Of Encrustationmentioning

confidence: 99%

The encrustation and blockage of long-term indwelling bladder catheters: a way forward in prevention and control

2010

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Objectives: To review the literature showing that understanding how Foley catheters become encrusted and blocked by crystalline bacterial biofilms has led to strategies for the control of this complication in the care of patients undergoing long-term indwelling bladder catheterization. Methods: A comprehensive PubMed search of the literature published between 1980 and December 2009 was made for relevant articles using the Medical Subject Heading terms 'biofilms', 'urinary catheterization', 'catheter-associated urinary tract infection' and 'urolithiasis'. Papers on catheterassociated urinary tract infections and bacterial biofilms collected during 40 years of working in the field were also reviewed. Results: There is strong experimental and epidemiological evidence that infection by Proteus mirabilis is the main cause of the crystalline biofilms that encrust and block Foley catheters. The ability of P. mirabilis to generate alkaline urine and to colonize all available types of indwelling catheters allows it to take up stable residence in the catheterized tract in bladder stones and cause recurrent catheter blockage. Conclusion: The elimination of P. mirabilis by antibiotic therapy as soon as it appears in the catheterized urinary tract could improve the quality of life for many patients and reduce the current expenditure of resources when managing the complications of catheter encrustation and blockage. For patients who are already chronic blockers and stone formers, antibiotic treatment is unlikely to be effective owing to the resistance of cells in the crystalline biofilms. Strategies such as increasing fluid intake with citrated drinks could control the problem until bladder stone removal can be organized.

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Section: Nature Of Encrustationmentioning

confidence: 99%

The encrustation and blockage of long-term indwelling bladder catheters: a way forward in prevention and control

2010

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“…8 Furthermore, the relationship between Proteus bacteriuria and urinary catheter encrustation and blockage is well documented. 9,10 Proteus bacteriuria has likewise been documented in persons with SCI, 1,11,12 but not specifically in association with stones. Two retrospective reports published two decades ago of almost 6000 patients with SCI found that bladder calculi were associated with the complete injuries and with Klebsiella bacteriuria.…”

Section: Discussionmentioning

confidence: 99%

Proteus bacteriuria is associated with significant morbidity in spinal cord injury

2006

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Study Design: Retrospective chart review. Objectives: We investigated the morbidity associated with Proteus bacteriuria in a spinal cord injured (SCI) population. Setting: Michael E DeBakey Veterans Affairs Medical Center in Houston, Texas, USA. Methods: We reviewed the medical records of all veterans with SCI who received care in our medical center during the past 3 years. Proteus bacteriuria was defined as the growth of Proteus species in any urine culture during the study period. Urinary stones were defined as either renal or bladder calculi. Results: During the study period, 71 of the 501 subjects (14%) had Proteus and 90 (18%) had urinary stones. Twenty-seven percent of the subjects with Proteus had stones, and the association of Proteus with stones was significant (Po0.05). Proteus bacteriuria was likewise associated with complete injury, hospitalization, decubitus ulcers, and history of stones (Po0.001). Subjects using indwelling catheters, either transurethral or suprapubic, were significantly more likely to have Proteus, whereas subjects practising spontaneous voiding and clean intermittent catheterization were significantly less likely to have Proteus. In the 90 patients with stones, Proteus was associated with requiring treatment for stones and having multiple stones (Po0.01). Twenty-five of the 90 patients with stones (28%) required treatment, most often with lithotripsy, and 6 (7%) developed urosepsis. Conclusions: In persons with SCI, Proteus was found in subjects with a greater degree of impairment who were more likely to be hospitalized, to have decubiti, and to use indwelling catheters. Bacteriuria with Proteus predicted urologic complications in persons with SCI. Statement of Ethics: All applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

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“…O biofilme é um material que consiste de bactéria com polissacarídeo extracelular (slime) e contém íons de cálcio e magnésio, a proteína Tamm-Horsfall da urina e ocasionalmente estruvita de organismos produtores de urease (Nicolle, 2001). O biofilme contribui para o bloqueio do cateter, o qual está relacionado com a infecção urinária causada por Proteus mirabilis (Kunin, 1989;Mobley e Warren, 1987;Stickler et al, 1993;Struble et al, 2009).…”

Section: Methodsunclassified

“…Ainda não existem métodos disponíveis para o controle efetivo do problema (Jones et al, 2005b). Devido à importância da incrustação no desempenho dos cateteres urinários, este assunto vem sendo estudado por Barford et al (2008), Bettio et al (2008a, b), Camargo et al (2005a, b), Jones et al (2005a, b), Lawrence e Turner (2005), Mathur et al (2006), Pizzolitto et al (2002), Santos e Pizzolitto (2007, 2008, Santos et al (2008a, b, c), Shaw et al (2005), , Stickler et al (1993), Stickler e Morgan (2008) e Tunney et al (1997). O objetivo do presente estudo foi investigar a formação de biofilme cristalino no lúmen interno de cateter urológico.…”

Section: Methodsunclassified