Abstract
Urinary or ureteral catheter insertion remains one of the most common urological procedures, yet is considered a predisposing factor for urinary tract infection. Diverse bacterial consortia adhere to foreign body surfaces and create various difficult to treat biofilm structures. We analyzed 347 urinary catheter- and stent-related samples, treated with sonication, using both routine culture and broad-range 16S rDNA PCR followed by Denaturing Gradient Gel Electrophoresis and Sanger sequencing (PCR-DGGE-S). In 29 selected samples, 16S rRNA amplicon Illumina sequencing was performed. The results of all methods were compared. In 338 positive samples, from which 86.1% were polybacterial, 1,295 representatives of 153 unique OTUs were detected. Gram-positive microbes were found in 46.5 and 59.1% of catheter- and stent-related samples, respectively. PCR-DGGE-S was shown as a feasible method with higher overall specificity (95 vs. 85%, p < 0.01) though lower sensitivity (50 vs. 69%, p < 0.01) in comparison to standard culture. Molecular methods considerably widened a spectrum of microbes detected in biofilms, including the very prevalent emerging opportunistic pathogen Actinotignum schaalii. Using massive parallel sequencing as a reference method in selected specimens, culture combined with PCR-DGGE was shown to be an efficient and reliable tool for determining the composition of urinary catheter-related biofilms. This might be applicable particularly to immunocompromised patients, in whom catheter-colonizing bacteria may lead to severe infectious complications. For the first time, broad-range molecular detection sensitivity and specificity were evaluated in this setting. This study extends the knowledge of biofilm consortia composition by analyzing large urinary catheter and stent sample sets using both molecular and culture techniques, including the widest dataset of catheter-related samples characterized by 16S rRNA amplicon Illumina sequencing.
Highlights
Inserting urinary or Double-J catheters (DJC) is one of the most common urological interventions
We evaluated 16S rRNA PCR-Denaturing Gradient Gel Electrophoresis (DGGE)-S, and routine conventional culture’s capability to determine the urinary and ureteral catheter biofilms’ bacterial communities
The purpose of the study was to describe the bacterial composition of urinary and ureteral catheter biofilms and catheter-related samples and to compare the performance of culture and PCR-DGGE-S in a low scale setting, using 16S rRNA Illumina sequencing as a reference method in selected specimens
Summary
Inserting urinary (so-called Foley) or Double-J catheters (DJC) is one of the most common urological interventions. Only a small part of generally colonized catheters develop into typically biofilm CAUTI, colonization is just enough to represent a risk for immunocompromised patients, cause financial loss, prolong patients’ hospitalization, and impede clinical management. Despite this fact, urinary and ureteral catheter colonization has not been extensively studied yet, taking into account broad-range molecular techniques. Gram-negative rods predominate on urinary catheters, while gram-positive cocci prevail on stents (Paick et al, 2003; Frank et al, 2009; Holá et al, 2010; Bonkat et al, 2011, 2012b, 2013; Choe et al, 2012; Xu et al, 2012; Klis et al, 2014). Routine urine culture provides valuable quantitative information enabling us to distinguish between contamination/colonization and aetiological agents (Hooton et al, 2010), but results can be negatively influenced by known culture pitfalls
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