Abstract
Catheter-associated urinary tract infections (CAUTIs) are nosocomial infections, causing more than one million cases per year. CAUTIs cause serious health issues; in addition, the cost of replacement of the device constrains the employment of urological devices. Therefore, there is an urgent need to develop novel biomaterials for use in catheters. In this study, poly hydroxyethyl-methacrylate p(HEMA) and drugs-loaded p(HEMA) with ampicillin trihydrate (AMP), levofloxacin (LVX), and drug combinations were prepared using free radical polymerization. The characterization of the dried films included the determination of glass transition temperature (Tg), ultimate tensile strength, elongation percentage, and Young’s modulus. Formulation toxicity, antimicrobial activity, and biofilm-formation ability were tested. Decreases in Tg value, U.T.S., and Young’s modulus, and an increase in elongation percentage were observed in AMP-loaded p(HEMA). Different ratios of drug combinations increased the Tg values. The films exhibited a cell viability higher than 80% on HEK 293 cells. Antimicrobial activity increased when p(HEMA) was loaded with LVX or a combination of LVX and AMP. Biofilm-forming ability reduced after the addition of antimicrobial agents to the films. p(HEMA) impregnated with AMP, LVX, and drug combinations showed significantly increased antimicrobial activity and decreased biofilm-forming ability compared with p(HEMA), in addition to the effects on (HEMA) mechanical properties.
Highlights
The insertion of medical devices such as urinary catheters and stents is often reported to increase the risk of developing bladder infections [1,2]
This study addressed the well-documented challenges of developing antimicrobial devices capable of resisting microbial growth and subsequent biofilm formation
The results showed that p(HEMA) alone without drug loading led to an enormous growth of microorganisms (Figure 5), which highlights the necessity of employing microbicides
Summary
The insertion of medical devices such as urinary catheters and stents is often reported to increase the risk of developing bladder infections [1,2]. Bacteria can colonize the outer surface of the catheter and lead to bacterial escape through the bladder and cause extraluminal infection. Bacterial adhesion is the rate-limiting step of infection development on the surface of implants [3,4]. It initiates the formation of infections via enhancing the attachment and colonization of bacteria in the host cells [5]. Microorganisms can aggregate irreversibly on the surface of the urinary devices. This leads to the formation of biofilm, which is a complex structure composed of glycocalyx, made of carbohydrates, proteins, and nucleic acid [7]. Biofilms maximize the resistance of microorganisms against microbicide by 10–1000 times compared with their planktonic complement, and make the treatments more difficult, necessitating the replacement of the medical device with a new one [8]
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