Poloxamer 338 Affects Cell Adhesion and Biofilm Formation in Escherichia coli: Potential Applications in the Management of Catheter-Associated Urinary Tract Infections.

Mariarita Stirpe,Iolanda Francolini,Gianfranco Donelli,Claudia Vuotto,Benedetta Brugnoli

doi:10.3390/pathogens9110885

Abstract

Poloxamers are nontoxic, amphiphilic copolymers used in different formulations. Due to its surfactant properties, Poloxamer 338 (P388) is herein proposed as a strategy to avoid biofilm formation often causing recalcitrant catheter-associated urinary tract infections (CAUTI). The aim is to evaluate the ability of P388 coatings to affect the adhesion of Ec5FSL and Ec9FSL Escherichia coli strains on silicone urinary catheters. Attenuated total reflection infrared spectroscopy, atomic force microscopy, and static water contact angle measurement were employed to characterize the P388-coated silicone catheter in terms of amount of P388 layered, coating thickness, homogeneity, and hydrophilicity. In static conditions, the antifouling power of P388 was defined by comparing the E. coli cells adherent on a hydrophilic P388-adsorbed catheter segment with those on an uncoated one. A P388-coated catheter, having a homogeneous coverage of 35 nm in thickness, reduced of 0.83 log10 and 0.51 log10 the biofilm of Ec5FSL and Ec9FSL, respectively. In dynamic conditions, the percentage of cell adhesion on P388-adsorbed silicone channels was investigated by a microfluidic system, simulating the in vivo conditions of catheterized patients. As a result, both E. coli isolates were undetected. The strong and stable antifouling property against E. coli biofilm lead us to consider P388 as a promising anti-biofilm agent for CAUTIs control.

Highlights

Some of the most common infections acquired in both acute care hospitals and post-acute healthcare settings, such as the rehabilitation units, are the urinary tract infections (UTIs), representing around40% of healthcare-associated infections (HAIs) [1] and being attributable for around 75% to use of an indwelling urinary catheter [2]
The efficacy of the P388 poloxamer (Figure 1) as antifouling coating for silicone urinary catheters was investigated against biofilm-forming E. coli strains causing catheter-associated urinary tract infections (CAUTI)
P388-modified system permitted to study biofilm formation under a shear rate that is a typical condition in urinary catheterization

Summary

Introduction

Some of the most common infections acquired in both acute care hospitals and post-acute healthcare settings, such as the rehabilitation units, are the urinary tract infections (UTIs), representing around. 40% of healthcare-associated infections (HAIs) [1] and being attributable for around 75% to use of an indwelling urinary catheter [2]. The most important risk factor for developing catheter-associated urinary tract infections (CAUTIs) is the prolonged use of an indwelling catheter, followed by female sex, diabetes mellitus, catheter insertion outside the operating room, and a breach in the closed system of catheter drainage [3]. A number of diseases require long-term bladder catheterization, both those related to acute pathologies that have damaged the bladder, and those associated to chronic conditions, such as cerebrovascular accidents, spinal injury or neurological diseases, including Alzheimer, Parkinson, Pathogens 2020, 9, 885; doi:10.3390/pathogens9110885 www.mdpi.com/journal/pathogens. Especially in hospitalized patients, to isolate from their urines multidrug- and extensively drug-resistant microorganisms, such as extended-spectrum beta-lactamase (ESBL)-producing bacteria, AmpC β-lactamases producers, and carbapenem-resistant Enterobacteriaceae [9,10,11]

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Conclusion