Abstract
BackgroundLong-term use of urethral catheters is associated with high risk of urinary tract infection (UTI) and blockage. Microbial biofilms are a common cause of catheter blockage, reducing their lifetime and significantly increasing morbidity of UTIs. A 0.02% polyhexanide irrigation solution developed for routine mechanical rinsing shows potential for bacterial decolonization of urethral catheters and has the potential to reduce or prevent biofilm formation.MethodsUsing an in vitro assay with standard market-leading types of catheters artificially contaminated with clinically relevant bacteria, assays were carried out to evaluate the biofilm reduction and prevention potential of a 0.02% polyhexanide solution versus no intervention (standard approach) and irrigation with saline solution (NaCl 0.9%). The efficiency of decolonization was measured through microbial plate count and membrane filtration.ResultsIrrigation using a 0.02% polyhexanide solution is suitable for the decolonization of a variety of transurethral catheters. The effect observed is significant compared to irrigation with 0.9% saline solution (p = 0.002) or no treatment (p = 0.011). No significant difference was found between irrigation with 0.9% saline solution and no treatment (p = 0.74).ConclusionsA 0.02% polyhexanide solution is able to reduce bacterial biofilm from catheters artificially contaminated with clinically relevant bacteria in vitro. The data shows a reduction of the viability of thick bacterial biofilms in a variety of commercially available urinary catheters made from silicone, latex-free silicone, hydrogel-coated silicone and PVC. Further research is required to evaluate the long-term tolerability and efficacy of polyhexanide in clinical practice.
Highlights
Long-term use of urethral catheters is associated with high risk of urinary tract infection (UTI) and blockage
We investigated the potential of a polyhexanide solution to reduce and prevent biofilm formation under in vitro conditions in a variety of artificially colonized catheters
We observed that treatment with the Uro-Tainer® 0.02% PHMB solution effectively reduced the biofilms artificially formed in the different catheter types as measured in after rinsing/membrane filtration (Fig. 1a) as well as in the swab samples (Fig. 1b)
Summary
Long-term use of urethral catheters is associated with high risk of urinary tract infection (UTI) and blockage. Brill et al BMC Urol (2021) 21:58 are able to colonize catheters: commensal species of bacteria from the gastrointestinal tract or ascending from the urethra, or bacteria transferred from the insertion site [2, 3]. Pathogens such as Escherichia coli, Enterobacter spp., Pseudomonas spp., Enterococcus spp., Staphylococcus aureus, coagulase-negative staphylococci and yeasts are common causes of urinary tract infections and catheter blockage [3, 4] and the most commonly reported species forming biofilms on urethral catheters are Candida spp., Pseudomonas aeruginosa, Proteus mirabilis, E. faecalis, and S. aureus [2, 3]. Scanning electron microscopy performed on biofilms formed on indwelling catheters has shown depths ranging from 3 to 490 μm and up to 400 visible bacterial cells deep [5]
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