Pilot Ex Vivo and In Vitro Evaluation of a Novel Foley Catheter with Antimicrobial Periurethral Irrigation for Prevention of Extraluminal Biofilm Colonization Leading to Catheter-Associated Urinary Tract Infections (CAUTIs)

Nylev Vargas-Cruz,Joel Rosenblatt,Ray Hachem,Ruth A Reitzel,Issam Raad,Anne-Marie Chaftari

doi:10.1155/2019/2869039

Abstract

CAUTI remains a serious healthcare issue for incontinent patients whose urine drainage is managed by catheters. A novel double-balloon Foley catheter was developed which was capable of irrigating the extraluminal catheter surfaces within the periurethral space between the urethral-bladder junction and meatus. The catheter has a retention cuff that is inflated to secure the catheter in the bladder and a novel irrigation cuff proximal to the urethral-bladder junction capable of providing periurethral irrigation from the urethral-bladder junction to the meatus. Uniform periurethral irrigation was demonstrated in an ex vivo porcine model by adding a dye to the antimicrobial urethral irrigation solution. An in vitro biofilm colonization model was adapted to study the ability of periurethral irrigation with a newly developed antimicrobial combination consisting of polygalacturonic acid + caprylic acid (PG + CAP) to prevent axial colonization of the extraluminal urethral indwelling catheter shaft by common uropathogens. The extraluminal surface of control catheters that were not irrigated formed biofilms along the entire axial urethral tract after 24 hours. Significant (p < 0.001) inhibition of colonization was seen against multidrug-resistant Pseudomonas aeruginosa (PA), carbapenem-resistant Escherichia coli (EC), and carbapenem-resistant Klebsiella pneumoniae (KB). For other common uropathogens including Candida albicans (CA), Proteus mirabilis (PR), and Enterococcus faecalis (EF), a first irrigation treatment completely inhibited colonization of half of the indwelling catheter closest to the bladder and a second treatment largely disinfected the remaining intraurethral portion of the catheter towards the meatus. The novel Foley catheter and PG + CAP antimicrobial irrigant prevented biofilm colonization in an in vitro CAUTI model and merits further testing in an in vivo CAUTI prevention model.

Highlights

A novel doubleballoon Foley catheter was developed which was capable of irrigating the extraluminal catheter surfaces within the periurethral space between the urethral-bladder junction and meatus. e catheter has a retention cuff that is inflated to secure the catheter in the bladder and a novel irrigation cuff proximal to the urethral-bladder junction capable of providing periurethral irrigation from the urethral-bladder junction to the meatus
An in vitro biofilm colonization model was adapted to study the ability of periurethral irrigation with a newly developed antimicrobial combination consisting of polygalacturonic acid + caprylic acid (PG + CAP) to prevent axial colonization of the extraluminal urethral indwelling catheter shaft by common uropathogens. e extraluminal surface of control catheters that were not irrigated formed biofilms along the entire axial urethral tract after 24 hours
BioMed Research International catheter sourced from organisms contaminating the urethral meatus [5, 6]. e subsequent development of biofilm by colonizing uropathogens is common in catheterassociated urinary tract infections (CAUTIs) since many express an array of adhesins and exopolysaccharides which promote attachment and biofilm formation on the catheter surface [7]

Summary

Methods

E design, illustrated, contained two cuffs: a distal cuff to retain the tip of the catheter in the bladder and a proximal irrigation cuff residing just below the urethral-bladder junction capable of disinfecting and lubricating or medicating the periurethral space contacting the external surface of the shaft of the catheter (Figure 1(a)). Position “0” is taken as the proximal base of the irrigation cuff where the irrigation solution first contacts the periurethral surfaces Distal to this point is denoted by negative lengths, where the urethralbladder junction would correspond to position –10 mm and the drainage tip of the catheter residing in the bladder corresponds to length position –30 mm. E PG + CAP + HEC and control irrigation solutions were tested in the model to assess their effect on biofilm colonization of the external surface of the Foley catheter towards the bladder. Visible drainage was completed in about 15 minutes, but some residual irrigation solution coated the external surface of the catheter shaft

Biofilm Colonization Experiments

C Biofilm

B Cut 10 mm segments

Findings

Discussion