Antimicrobial-coated Catheters Research Articles

A new dynamic in vitro model for evaluating antimicrobial activity against bacterial biofilms on central venous catheters.

Central venous catheters (CVCs) are widely used for intravenous medication administration. However, biofilm formation along the catheter surface is the main most important cause of catheter-related bloodstream infections. Nowadays, several antimicrobial-coated catheters are available to prevent biofilm development. In this study, we introduced a new dynamic in vitro model to evaluate the antimicrobial activity against bacterial biofilms on CVCs. Rifampicin-minocycline-coated catheters and control catheters without antimicrobial component were assembled into the model to test the antimicrobial activity on external surface and internal surface. After 1 h irrigation of Staphylococcus epidermidis or Staphylococcus aureus preculture and 23 h irrigation of Trypticase Soy Broth, the viable adherent organism was collected and counted. The enumeration results showed that the number of bacteria attached to antibacterial catheter was significantly less than that of the control catheter, both on external surface (P < 0.05) and internal surface (P < 0.05). The results were further confirmed by the scanning electron microscopy. In conclusion, the dynamic in vitro model can be applied to evaluate the antimicrobial activity against bacterial biofilms grown on the external and internal surfaces of CVCs used in clinical practice.IMPORTANCEFor the first time, a new dynamic in vitro model was constructed to evaluate the antimicrobial activity against bacterial biofilms on central venous catheters (CVCs) on both external surface and internal surface. This model could be applied to evaluate the antimicrobial activity against bacterial biofilms not only on CVCs but also other types of catheters.

MP60-03 ORGANO-SELENIUM URINARY CATHETERS INHIBIT GROWTH AND BIOFILM FORMATION OF E. COLI , K. PNEUMONIAE , P. AERUGINOSA, AND H. INFLUENZAE IN-VITRO

You have accessJournal of UrologyCME1 Apr 2023MP60-03 ORGANO-SELENIUM URINARY CATHETERS INHIBIT GROWTH AND BIOFILM FORMATION OF E. COLI, K. PNEUMONIAE, P. AERUGINOSA, AND H. INFLUENZAE IN-VITRO Rachel Vopni, Unique Jacobo, Phat Tran, Shruti Patel, Suyash Jain, Cornelia De Riese, Ted Reid, and Werner De Riese Rachel VopniRachel Vopni More articles by this author , Unique JacoboUnique Jacobo More articles by this author , Phat TranPhat Tran More articles by this author , Shruti PatelShruti Patel More articles by this author , Suyash JainSuyash Jain More articles by this author , Cornelia De RieseCornelia De Riese More articles by this author , Ted ReidTed Reid More articles by this author , and Werner De RieseWerner De Riese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003318.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Catheter-associated urinary tract infections (CAUTIs) are of significant medical burden in cost, morbidity, and mortality. Experimental selenium-coated medical devices have demonstrated nontoxic in-vitro and in-vivo antimicrobial activity due to the ability of selenium to catalyze formation of superoxide radicals. While antimicrobial-coated catheters have shown efficacy in preventing CAUTIs, selenium has not been tested in this context. The purpose of this in-vitro study is to evaluate selenium-incorporated urinary catheters for inhibition of uropathogenic bacterial growth and biofilm formation. METHODS: Urinary catheters incorporated with 1% organo-selenium and standard (uncoated) catheters were incubated in-vitro with E. coli, K. pneumoniae, P. aeruginosa, H. influenzae, and combinations of these bacteria. Growth was evaluated by colony forming unit count and visualized with confocal laser and scanning electron microscopy. Organo-selenium catheter material integrity was also tested by soaking the tubing in phosphate-buffered saline for 12-weeks at 37°C. RESULTS: Organo-selenium-incorporated catheters demonstrated total reduction (100%) of in-vitro bacterial growth and biofilm formation for E. coli, K. pneumoniae, H. influenzae, and a combination of these species when compared to control. P. aeruginosa growth was inhibited by approximately 4 logs (99.99%). Complete inhibition of E. coli growth was maintained after long-term phosphate-buffered saline soaking. CONCLUSIONS: The results demonstrate that organo-selenium was stably incorporated into catheter tubing and inhibited bacterial attachment, growth, and biofilm formation for multiple uropathogenic organisms. Furthermore, long-term soaking of organo-selenium tubing in phosphate-buffered saline did not show any decline in bacterial growth inhibition or biofilm formation. These findings suggest that organo-selenium-incorporated catheters may be advantageous in preventing CAUTIs and warrant further in-vivo and clinical evaluation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e843 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rachel Vopni More articles by this author Unique Jacobo More articles by this author Phat Tran More articles by this author Shruti Patel More articles by this author Suyash Jain More articles by this author Cornelia De Riese More articles by this author Ted Reid More articles by this author Werner De Riese More articles by this author Expand All Advertisement PDF downloadLoading ...

Efficacy of organo-selenium-incorporated urinary catheter tubing for in vitro growth inhibition of E. coli, K. pneumoniae, P. aeruginosa, and H. influenzae.

Catheter-associated urinary tract infections are of significant medical burden in cost, morbidity, and mortality. Experimental selenium-coated medical devices have demonstrated non-toxic in vitro and in vivo antimicrobial activity. While antimicrobial-coated catheters have shown efficacy in preventing CAUTIs, selenium has not been tested in this context. The purpose of this in vitro study is to evaluate selenium-incorporated urinary catheters for inhibition of uropathogenic bacterial growth and biofilm formation. Urinary catheters incorporated with 1% organo-selenium and standard (uncoated) catheters were incubated in vitro with E. coli, K. pneumoniae, P. aeruginosa, H. influenzae, and combinations of these bacteria. Growth was evaluated by colony-forming unit count and visualized with confocal laser and scanning electron microscopy. Organo-selenium catheter material integrity was also tested by soaking the tubing in phosphate-buffered saline for 12weeks at 37°C. Organo-selenium-incorporated catheters demonstrated total reduction (100%) of in vitro bacterial growth and biofilm formation for E. coli, K. pneumoniae, H. influenzae, and a combination of these species when compared to control. P. aeruginosa growth was inhibited by approximately 4 logs (99.99%). Complete inhibition of E. coli growth was maintained after long-term phosphate-buffered saline soaking. The results demonstrate that organo-selenium was stably incorporated into catheter tubing and inhibited bacterial attachment, growth, and biofilm formation for multiple uropathogenic organisms. Furthermore, long-term soaking of organo-selenium tubing in phosphate-buffered saline did not show any decline in bacterial growth inhibition or biofilm formation. These findings suggest that organo-selenium-incorporated catheters may be advantageous in preventing catheter-associated urinary tract infections and warrant further in vivo and clinical evaluation.

Editorial Commentary

No AccessUrology PracticePatient Care1 Nov 2021Editorial CommentaryThis article comments on the following:Use of Antimicrobial-Coated Catheters in Preventing Catheter-Associated Urinary Tract Infections and Bacteriuria: A Meta-Analysis for Cliniciansis a letter which has replyReply by Authors Richard A. Watson Richard A. WatsonRichard A. Watson HMH School of Medicine, Nutley, New Jersey More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000254.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, 8(6), p. 712 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesUrology PracticeAug 18, 2021, 12:00:00 AMUse of Antimicrobial-Coated Catheters in Preventing Catheter-Associated Urinary Tract Infections and Bacteriuria: A Meta-Analysis for CliniciansUrology PracticeAug 18, 2021, 12:00:00 AMReply by Authors Volume 8Issue 6November 2021Page: 712-712 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Richard A. Watson HMH School of Medicine, Nutley, New Jersey More articles by this author Expand All Advertisement Loading ...

Use of Antimicrobial-Coated Catheters in Preventing Catheter-Associated Urinary Tract Infections and Bacteriuria: A Meta-Analysis for Clinicians

Catheter-associated urinary tract infections comprise a significant burden to the health care system and are of major concern for indwelling catheter use. Catheter coatings have been studied for their potential to reduce risk of infection. The purpose of this meta-analysis is to determine the efficacy of coated catheters across clinical studies in preventing these common nosocomial infections. Searches were conducted on PubMed Central® and ScienceDirect using the terms "catheter," "urinary tract infection" and "coated" or "antimicrobial." Articles included were prospective randomized clinical studies of coated (experimental) vs uncoated (control) catheters published in English between the years 2000 and 2020. Results from included studies were analyzed using Fisher's exact test and conditional logistic regression. Fifteen studies met the inclusion criteria. Tested urinary catheter coatings include silver, silver salt, nitrofurazone and metal-alloy. Conditional logistic regression (p <0.001) shows statistically significant negative association between coated catheter use and the incidence of catheter-associated urinary tract infections. The odds ratio of 0.80 and 95% confidence interval (0.74, 0.88) support protective effect of catheter coatings. Meta-analysis demonstrates a negative association of coated catheter and incidence of catheter-associated urinary tract infections, supporting that antimicrobial catheter coatings decreases incidence of infection across studies. Further clinical research is recommended to determine the potential for catheter coating adoption in clinical practice to reduce catheter-associated urinary tract infection risk and incidence.

A Glance at Antimicrobial Strategies to Prevent Catheter-Associated Medical Infections.

Urinary and intravascular catheters are two of the most used invasive medical devices; however, microbial colonization of catheter surfaces is responsible for most healthcare-associated infections (HAIs). Several antimicrobial-coated catheters are available, but recurrent antibiotic therapy can decrease their potential activity against resistant bacterial strains. The aim of this Review is to question the actual effectiveness of currently used (coated) catheters and describe the progress and promise of alternative antimicrobial coatings. Different strategies have been reviewed with the common goal of preventing biofilm formation on catheters, including release-based approaches using antibiotics, antiseptics, nitric oxide, 5-fluorouracil, and silver as well as contact-killing approaches employing quaternary ammonium compounds, chitosan, antimicrobial peptides, and enzymes. All of these strategies have given proof of antimicrobial efficacy by modifying the physiology of pathogens or disrupting their structural integrity. The aim for synergistic approaches using multitarget processes and the combination of both antifouling and bactericidal properties holds potential for the near future. Despite intensive research in biofilm preventive strategies, laboratorial studies still present some limitations since experimental conditions usually are not the same and also differ from biological conditions encountered when the catheter is inserted in the human body. Consequently, in most cases, the efficacy data obtained from in vitro studies is not properly reflected in the clinical setting. Thus, further well-designed clinical trials and additional cytotoxicity studies are needed to prove the efficacy and safety of the developed antimicrobial strategies in the prevention of biofilm formation at catheter surfaces.

An investigation of the effectiveness against bacteriuria of silver-coated catheters in short-term urinary catheter applications: A randomized controlled study

AimThe aim of this study was to investigate the effectiveness of antimicrobial-coated catheters against bacteriuria and urinary tract infection in patients who have urinary catheterization. MethodsTwenty eight and twenty six people similar in terms of demographic characteristics and primary and underlying diseases were randomly selected from patients undergoing short-time urinary catheterization in the intensive care unit. Silver-coated slicone foley catheters and normal slicone foley catheters were used for uninary catheterization in the first and second group of the patients respectively. Urine specimens were collected from patients at 2-day intervals and assessed in terms of bacteriuria. ResultsBacteriuria was found in 12 (46.2%) of the patients using normal catheters and 13 (46.4%) of those using silver-coated catheters throughout the monitoring period. No significant relationship was determined between use of different catheter types and bacteriuria (p = 0.98). The most common microorganism was identified as E. coli in the normal catheter group while microorganism other than E. coli was identified in the silver-coated catheter group. The prevalence of bacteriuria was statistically significantly higher in patients with a history of hospitalization in the previous 3 months (p = 0.028). ConclusionThe use of silver-coated silicone catheters was not shown to have a protective effect against bacteriuria in this study. Further well-designed studies with larger case numbers are now needed to confirm whether history of hospitalization, which emerged as a statistically significant factor in this study, increases the prevalence of catheter-related bacteriuria.

Irrigation with N,N-dichloro-2,2-dimethyltaurine (NVC-422) in a citrate buffer maintains urinary catheter patency in vitro and prevents encrustation by Proteus mirabilis.

Long-term use of indwelling urinary catheters can lead to urinary tract infections and loss of catheter patency due to encrustation and blockage. Encrustation of urinary catheters is due to formation of crystalline biofilms by urease-producing microorganisms such as Proteus mirabilis. An in vitro catheter biofilm model (CBM) was used to evaluate current methods for maintaining urinary catheter patency. We compared antimicrobial-coated urinary Foley catheters, with both available catheter irrigation solutions and investigational solutions containing NVC-422 (N,N-dichloro-2,2-dimethyltaurine; a novel broad-spectrum antimicrobial). Inoculation of the CBM reactor with 10(8) colony-forming units of P. mirabilis resulted in crystalline biofilm formation in catheters by 48h and blockage of catheters within 5days. Silver hydrogel or nitrofurazone-coated catheters did not extend the duration of catheter patency. Catheters irrigated daily with commercially available solutions such as 0.25% acetic acid and isotonic saline blocked at the same rate as untreated catheters. Daily irrigations of catheters with 0.2% NVC-422 in 10mM acetate-buffered saline pH 4 or Renacidin maintained catheter patency throughout 10-day studies, but P. mirabilis colonization of the CBM remained. In contrast, 0.2% NVC-422 in citrate buffer (6.6% citric acid at pH 3.8) resulted in an irrigation solution that not only maintained catheter patency for 10days but also completely eradicated the P. mirabilis biofilm within one treatment day. These data suggest that an irrigation solution containing the rapidly bactericidal antimicrobial NVC-422 in combination with citric acid to permeabilize crystalline biofilm may significantly enhance catheter patency versus other approved irrigation solutions and antimicrobial-coated catheters.

New technology: heparin and antimicrobial-coated catheters.

Although tunneled hemodialysis catheter must be considered the last option for vascular access, it is necessary in some circumstances in the dialysis patient. Thrombosis and infections are the main causes of catheter-related comorbidity. Fibrin sheath, intimately related with the biofilm, is the precipitating factor of this environment, determining catheter patency and patient morbidity. Its association with bacterial overgrowth and thrombosis has led to the search of multiple preventive measures. Among them is the development of catheter coatings to prevent thrombosis and infections. There are two kinds of treatments to cover the catheter surface: antithrombotic and antimicrobial coatings. In nondialysis-related settings, mainly in intensive care units, both have been shown to be efficient in the prevention of catheter-related infection. This includes heparin, silver, chlorhexidine, rifampicine and minocycline. In hemodialysis population, however, few studies on surface-treated catheters have been made and they do not provide evidence that shows complication reduction. The higher effectiveness of coatings in nontunneled catheters may depend on the short average life of these devices. Hemodialysis catheters need to be used over long periods of time and require clinical trials to show effectiveness of coatings over long periods. This also means greater knowledge of biofilm etiopathogeny and fibrin sheath development.

Estimating the duration of a central venous catheter at time of insertion

The aim of this study was to investigate whether clinicians can estimate, at the time of insertion, the length of time a central venous catheter (CVC) will remain in place, and to identify clinical variables which may predict CVC duration. CVC-related bloodstream infection is a known complication among critically ill patients. As infection rates may increase with duration of catheterization, more expensive antimicrobial-coated catheters may be used in patients with anticipated long duration of CVC use.

Advances in prevention and management of central line-associated bloodstream infections in patients with cancer.

Central lines, which are essential for treating cancer, are associated with at least 400,000 episodes of bloodstream infection in patients with cancer every year in the United States. Effective novel interventions for preventing and managing these infections include antimicrobial-coated catheters and antimicrobial lock solutions.

681 Effectiveness of short-term antiseptic and antimicrobial-coated urethral catheters in reducing catheter-associated urinary tract infections: Cochrane systematic review and meta-analysis

681 Effectiveness of short-term antiseptic and antimicrobial-coated urethral catheters in reducing catheter-associated urinary tract infections: Cochrane systematic review and meta-analysis

Incidence of Catheter-Associated Bloodstream Infection After Introduction of Minocycline and Rifampin Antimicrobial-Coated Catheters in a Pediatric Burn Population

The Centers for Disease Control and Prevention guidelines for prevention of intravascular catheter-related infections suggest that antimicrobial-coated catheters can decrease the risk of developing catheter-related bloodstream infection in a variety of adult patient populations. There are limited data on their efficacy in the pediatric population, particularly among children with burn injuries. A study was conducted at Shriners Hospitals for Children®, Boston, to determine whether minocycline/rifampin (MR)-coated catheters could decrease the incidence of catheter-associated bloodstream infection (CABSI) in a pediatric burn population. A historical control group included all patients with double- or triple-lumen catheters inserted in the 18-month period from January 2006 to June 2007. The study group included all patients with MR antimicrobial double- or triple-lumen catheters inserted in the subsequent 18-month period, July 2007 to December 2008. Data collected included name, age, date of burn/injury, date of admission, percent TBSA area burn injury or other diagnosis, catheter site (subclavian, internal jugular, or femoral), method of insertion (new percutaneous stick or guidewire), type of catheter (double or triple lumen), date inserted, duration of catheter placement (days), and positive blood cultures recovered while the central venous catheter was in place. CABSI was defined using the Centers for Disease Control and Prevention definition of laboratory-confirmed bloodstream infection. There were a total of 66 patients with 252 catheters (1780 catheter days) in the control group and 75 patients with 263 catheters (1633 catheter days) in the study group. Age, percent burn injury, catheter site, and method of insertion were not statistically different between the two groups. The percentage of infected catheters and the rate of infection were significantly different for the two groups, with the MR antimicrobial catheters only half as likely to become infected. In a subset of these patients with catheters in place for more than 4 days, the percentage of infected catheters and rate of infection were also significantly different with results similar to those in the entire group. MR antimicrobial-coated catheters significantly reduced the incidence of CABSI in this pediatric burn population compared with noncoated catheters.

New materials and devices for preventing catheter-related infections

Catheters are the leading source of bloodstream infections for patients in the intensive care unit (ICU). Comprehensive unit-based programs have proven to be effective in decreasing catheter-related bloodstream infections (CR-BSIs). ICU rates of CR-BSI higher than 2 per 1,000 catheter-days are no longer acceptable. The locally adapted list of preventive measures should include skin antisepsis with an alcoholic preparation, maximal barrier precautions, a strict catheter maintenance policy, and removal of unnecessary catheters. The development of new technologies capable of further decreasing the now low CR-BSI rate is a major challenge. Recently, new materials that decrease the risk of skin-to-vein bacterial migration, such as new antiseptic dressings, were extensively tested. Antimicrobial-coated catheters can prevent CR-BSI but have a theoretical risk of selecting resistant bacteria. An antimicrobial or antiseptic lock may prevent bacterial migration from the hub to the bloodstream. This review discusses the available knowledge about these new technologies.

New Challenges in the Diagnosis, Management, and Prevention of Central Venous Catheter-Related Infections

Catheters are the leading source of bloodstream infections in critically ill patients. Because the clinical signs of infection are nonspecific, such infections are overly suspected, which results in unnecessary removal of catheters. A conservative approach might be attempted in mild infections, whereas catheters should always be removed in cases of severe sepsis or septic shock. Nowadays, comprehensive unit-based improvement programs are effective to reduce catheter-related bloodstream infections (CR-BSIs). Rates of CR-BSI higher than 2 per 1000 catheter-days are no longer acceptable. A locally adapted checklist of preventive measures should include cutaneous antisepsis with alcoholic preparation, maximal barrier precaution, strict policy of catheter maintenance, and ablation of useless catheters. Antiseptic dressings and, to a lesser extent, antimicrobial-coated catheters, might be added to the prevention strategies if the level of infections remains high despite implementation of a prevention program. In the case of CR-BSI in intensive care units (ICUs), the catheter should be removed. In the case of persistence of fever or positive blood cultures after 3 days, inadequate antibiotic therapy, endocarditis, or thrombophlebitis should be ruled out.

Chlorhexidine Impregnated Central Venous Catheter Inducing an Anaphylatic Shock in the Intensive Care Unit

Chlorhexidine, a bisbiguanide, is widely used as an antiseptic agent in medical practice as it has the greatest residual antimicrobial activity. Central venous catheters coated extraluminally with chlorhexidine have been made to reduce extraluminal contamination. By using both the chlorhexidine-alchohol skin preparation and antimicrobial-coated catheters during vascular cannulation, it can reduce catheter related bloodstream significantly [1]. The reduction in infection rate is especially vital in critically ill patients who require long-term vascular access. Adverse reactions to chlorhexidine are rare and uncommon, and have been under-recognised as a cause of anaphylaxis. There are several reports of allergic reactions following exposure to chlorhexidine. We report of a case of anaphylaxis shock requiring cardiopulmonary resuscitation during the placement of a chlorhexidine impregnated central venous catheters.

Internet survey of Foley catheter practices and knowledge among Minnesota nurses

Although nurses insert and care for many Foley catheters, little is known about nurses' attitudes and knowledge regarding indications for catheter use or methods to prevent catheter-associated urinary tract infection (CAUTI). An Internet-based survey was sent to a random sample of registered nurses (RNs) in Minnesota. The survey contained demographic questions and 5-point Likert-scale questions regarding indications for Foley catheter placement and effectiveness of various interventions for preventing CAUTI. Nurses perceived early catheter removal as the most effective intervention to prevent CAUTI (mean score, 4.5; range 1-5). Compared with other RNs, those reporting additional catheter education were more likely to rate interventions to prevent CAUTI as effective, regardless of whether the interventions actually reduce the incidence of symptomatic CAUTI or asymptomatic bacteriuria/funguria. Intensive care unit RNs were significantly more likely than other RNs to endorse that a Foley catheter was indicated for any given clinical scenario and to endorse antimicrobial-coated catheters as effective in preventing CAUTI. Most respondents reported no institutional guidance regarding catheterization. Although the surveyed Minnesota RNs demonstrated high-level awareness of the utility of early Foley catheter removal for preventing CAUTI, other aspects of their catheter-related knowledge were concerning. Improving these deficits may help improve catheter-related practice.

Antimicrobial catheters in the ICU: is the juice worth the squeeze?

Catheter-related bloodstream infection is one of the most serious complications of central venous access devices. Antimicrobial-coated catheters represent one novel strategy to prevent catheter-related bloodstream infection. A comprehensive economic evaluation is essential to guide informed decision-making regarding the adoption of this technology and its expected benefits in healthcare institutions.

Use of Maximal Sterile Barrier Precautions and/or Antimicrobial-Coated Catheters to Reduce the Risk of Central Venous Catheter-Related Bloodstream Infection

Central venous catheter-related bloodstream infection is clinically important because of its high mortality rate. This prospective study shows by multivariate analysis that the use of maximal sterile barrier precautions (odds ratio, 5.205 [95% confidence interval, 0.015-1.136]; P=.023) and the use of antimicrobial-coated catheters (odds ratio, 5.269 [95% confidence interval, 0.073-0.814]; P=.022) are independent factors associated with a lowered risk of acquiring a central venous catheter-related bloodstream infection.

Zero Tolerance for Catheter-Related Bloodstream Infections: The Unnegotiable Objective

Many things are negotiable in life, but not life itself. Like many other healthcare-associated infections, catheter-related bloodstream infections (BSIs) are preventable life-threatening infections that often develop in seriously ill hospitalized patients. The central venous catheter (CVC) has become the lifeline for many critically ill patients, as well as chronically ill patients who have cancer or are undergoing hemodialysis. However, these same intravascular devices have also become the source of serious BSIs associated with high morbidity and mortality. 1 The prospective study by Lee et al. 2 published in this issue of the journal supports previous data in demonstrating the roles played by the use of maximal sterile barrier precautions and antimicrobial-coated catheters in reducing the risk of catheter-related BSI. In their study, the use of these 2 interventions had an independent and significant association with a decrease in the risk of catheter infection of more than fivefold, demonstrating that these 2 interventions could complement one another in aiding healthcare professionals at achieving this unnegotiable end point of zero incidence for catheter-related BSI. Like any other prospective study, the study of Lee et al. 2