Bacterial biofilm formation on indwelling urethral catheters.

H Pelling,J.M Sutton,L.J Bock,J Nzakizwanayo,B.V Jones,W.M Macfarlane,E.L Denham,S Milo

doi:10.1111/lam.13144

H Pelling, J.M Sutton + Show 6 more

Open Access

https://doi.org/10.1111/lam.13144

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Abstract

Urethral catheters are the most commonly deployed medical devices and used to manage a wide range of conditions in both hospital and community care settings. The use of long-term catheterization, where the catheter remains in place for a period >28days remains common, and the care of these patients is often undermined by the acquisition of infections and formation of biofilms on catheter surfaces. Particular problems arise from colonization with urease-producing species such as Proteus mirabilis, which form unusual crystalline biofilms that encrust catheter surfaces and block urine flow. Encrustation and blockage often lead to a range of serious clinical complications and emergency hospital referrals in long-term catheterized patients. Here we review current understanding of bacterial biofilm formation on urethral catheters, with a focus on crystalline biofilm formation by P. mirabilis, as well as approaches that may be used to control biofilm formation on these devices. SIGNIFICANCE AND IMPACT OF THE STUDY: Urinary catheters are the most commonly used medical devices in many healthcare systems, but their use predisposes to infection and provide ideal conditions for bacterial biofilm formation. Patients managed by long-term urethral catheterization are particularly vulnerable to biofilm-related infections, with crystalline biofilm formation by urease producing species frequently leading to catheter blockage and other serious clinical complications. This review considers current knowledge regarding biofilm formation on urethral catheters, and possible strategies for their control.

Highlights

Urethral catheters have been used in human medicine for over 3500 years
The use of long-term catheterisation, where the catheter remains in place for a period >28 days remains common, and the care of these patients is often undermined by the acquisition of infections and formation of biofilms on catheter surfaces
Summary Bacterial biofilms remain a major problem in the care of many patients and continue to undermine the successful treatment of many infections

Summary

Introduction

Urethral catheters have been used in human medicine for over 3500 years. The term catheter derives from the ancient Greek kathiénai, which can be translated as “to thrust into” or “to send down”, and describes a medical device used to drain fluid from a body cavity (Mattelaer and Billiet 1995; Feneley et al 2015). Congruent with this are estimates suggesting the cost of treating CAUTI and associated complications in long-term catheterised patients in the community may be as high as £10,000 per patient, along with studies highlighting the prevalence of emergency hospital referrals in this group (KohlerOckmore and Fenely 1996; Evans et al 2000) The use of these devices and the size of the global urinary catheter market is predicted to continue to grow, along with the complications associated with the use of current catheter designs and the formation of bacterial biofilms on these devices (Prinjha and Chapple 2013; Feneley et al 2015)

Biofilm formation and catheter encrustation

Findings

Approaches to control crystalline biofilm formation and catheter blockage