Encrustation of indwelling urethral catheters by Proteus mirabilis biofilms growing in human urine

doi:10.1016/S0195-6701(98)90262-6

Journal of Hospital Infection

Volume 39, Issue 3, July 1998, Pages 227-234

https://doi.org/10.1016/S0195-6701(98)90262-6 Get rights and content

Abstract

The encrustation and blockage of four types of urinary catheters was studied in a simple laboratory model of the catheterized bladder. Pooled human urine was supplied to the bladder chamber at 0·5 mL/min. The bladder urine was inoculated with a clinical strain of Proteus mirabilis that had been isolated from an encrusted catheter. The models were operated until the catheters blocked and atomic absorption spectrometry was used to assess the amounts of calcium and magnesium deposited on the catheters. Scanning electron microscopy was also used to locate and assess the degree of encrustation. All catheters blocked rapidly, the mean times to blockage ranging from 17·7 h (silver-coated latex), 34 h (hydrogel-coated latex), 38 h (silicone-coated latex) to 47 h (all silicone). The internal diameters of the latex catheters were only 1·5 mm compared to the 2·5 mm of the all-silicone catheters. The calcium and magnesium salts were deposited on the lumenal surfaces along the full length of catheters but occurred most extensively just below the eye-holes. There is clearly a need to develop catheter surfaces which resist encrustation by crystalline biofilms of P. mirabilis.

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The roles of intracellular and extracellular calcium in Bacillus subtilis biofilms
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In nature, bacteria reside in biofilms– multicellular differentiated communities held together by an extracellular matrix. This work identified a novel subpopulation—mineral-forming cells—that is essential for biofilm formation in Bacillus subtilis biofilms. This subpopulation contains an intracellular calcium-accumulating niche, in which the formation of a calcium carbonate mineral is initiated. As the biofilm colony develops, this mineral grows in a controlled manner, forming a functional macrostructure that serves the entire community. Consistently, biofilm development is prevented by the inhibition of calcium uptake. Our results provide a clear demonstration of the orchestrated production of calcite exoskeleton, critical to morphogenesis in simple prokaryotes.
An antimicrobial impregnated urinary catheter that reduces mineral encrustation and prevents colonisation by multi-drug resistant organisms for up to 12 weeks
2019, Acta Biomaterialia
Citation Excerpt :
The production of ammonia results in an alkaline urinary pH, causing precipitation of urinary minerals such as calcium, magnesium, and phosphate and their deposition on the catheter surfaces [2]. Crystal deposits can occlude the catheter lumen or drainage eyelets causing reflux of urine to the kidneys and/or bypass of urine around the outside of the catheter [2,3]. Some catheter users experience blockages as frequently as every seven to 10 days [4].
Two major complications of indwelling urinary catheterisation include infection and mineral encrustation of the catheter. Our antimicrobial urinary catheter (AUC) impregnated with rifampicin, triclosan, and sparfloxacin has demonstrated long-term protective activity against major uropathogens. This study aimed to firstly assess the ability of the AUC to resist mineral encrustation in the presence and absence of bacteria. Secondly, it aimed to investigate the AUC’s anti-biofilm activity against multi-drug resistant organisms. There was no difference in surface roughness between AUC and control segments. In a static and a perfusion model, phosphate deposition was significantly reduced on AUCs challenged with P. mirabilis. Furthermore, none of the AUCs blocked during the 28 day test period, unlike controls. The AUC prevented colonisation by methicillin-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus epidermidis, extended-spectrum beta-lactamase producing E. coli, and carbapenemase-producing E. coli for 12 consecutive weekly challenges. All three drugs impregnated into the catheter continued to exert protective activity throughout 12 weeks of constant perfusion. The drugs appear to migrate into the crystalline biofilm to continually protect against bacteria not it direct contact with the catheter surface. In conclusion, the AUC reduces mineral encrustation and may increase time to blockage in the presence of P. mirabilis, and does not predispose to mineral deposition under other conditions. It also offers 12 weeks of protection against multi-drug resistant bacteria.
Infection and associated mineral encrustation of urinary catheters are two serious complications of indwelling urinary catheters. Others have attempted to address this through various technologies such as coatings, dips, and surface modifications to prevent infection and/or encrustation. However, all current ‘anti-infective’ urinary catheter technologies are limited to short-term use. Some patients with spinal injuries, multiple sclerosis, stroke survivors and others use long-term catheters for 4–12 weeks at a time with multiple catheterisation possibly throughout the rest of their life. We present a urinary catheter for long-term use that is impregnated with three antimicrobials by a patient-protected process to prevent infection and encrustation for up to 12 weeks, the maximum lifetime of a long-term catheter before it is changed.
In vitro study on infectious ureteral encrustation resistance of Cu-bearing stainless steel
2017, Journal of Materials Science and Technology
Citation Excerpt :
In addition, the crystallization probably should be decreased by the antimicrobial activity of 316L-Cu SS, meaning that the antimicrobial ability of such a material may be also one of the reasons for inhibiting the encrustation. There have been some documents regarding the relationships between bacteria and encrustation, which is instructive for the research of anti-encrustation effect of 316L-Cu SS [6,14–16]. Microorganisms can influence the encrustation process in many ways and a well known one is the formation of infection stones by urease producing bacteria [17].
Cu-bearing stainless steel has been found to have obvious inhibition performance against encrustation in vitro. This study was aiming to further investigate the inhibitory effect of a Cu-bearing stainless steel (316L-Cu SS) on the infectious encrustation based on its antimicrobial activity. The encrustation in presence of bacteria, antibacterial performance, urease production and Ca and Mg precipitation were examined by scanning electron microscopy, antibacterial assay, enzyme-linked immunosorbent assay and inductively coupled plasma-mass spectrometry, respectively. It was found that 316L-Cu SS could inhibit the formation of bacterial biofilm due to the release of Cu²⁺ ions and then decrease the urease amount splitting by bacteria, which produced a neutral environment with pH around 7. However, more encrustations coupled with bacterial biofilms on the surface of comparison stainless steel (316L SS) with an alkaline environment were recorded. It can thus be seen that the 316L-Cu SS highlights prominent superiority against encrustation in the presence of microorganisms.
From Catheter to Kidney Stone: The Uropathogenic Lifestyle of Proteus mirabilis
2017, Trends in Microbiology
Proteus mirabilis is a model organism for urease-producing uropathogens. These diverse bacteria cause infection stones in the urinary tract and form crystalline biofilms on indwelling urinary catheters, frequently leading to polymicrobial infection. Recent work has elucidated how P. mirabilis causes all of these disease states. Particularly exciting is the discovery that this bacterium forms large clusters in the bladder lumen that are sites for stone formation. These clusters, and other steps of infection, require two virulence factors in particular: urease and MR/P fimbriae. Highlighting the importance of MR/P fimbriae is the cotranscribed regulator, MrpJ, which globally controls virulence. Overall, P. mirabilis exhibits an extraordinary lifestyle, and further probing will answer exciting basic microbiological and clinically relevant questions.
Bioactive biomaterials for controlling biofilms
2015, Biomaterials and Medical Device - Associated Infections
Indwelling medical devices are a cornerstone of modern surgical practice, providing effective, cost-effective and often simple solutions for the management of a range of clinical scenarios where support is required for the normal physiology of the body. However, their increasingly widespread use is significantly compromised by their propensity to become colonized by microorganisms, leading to medical device-associated infections, with at least half of all incidences of healthcare-associated infections in the National Health Service (UK) now linked to their use. This chapter reviews the processes leading to such infections and goes on to discuss the development of devices and emerging strategies which prevent microbial colonization, biofilm formation and infection via the coordination, control or triggered release of antimicrobial agents from polymeric systems in response to various infection-associated triggers.
Rapid determination of Proteus mirabilis susceptibility to antibiotics using infrared spectroscopy in tandem with random forest
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Journal of Hospital Infection

Abstract

References (21)

Formation of encrustations on indwelling urinary catheters in the elderly: a comparison of different types of catheter materials in “blockers” and “non-blockers”

J Urol

Bacterial and crystal adherence to the surfaces of indwelling urethral catheters

J Urol

The problem of catheter encrustation

Can Med Assoc J

Catheter encrustation by struvite

Br J Urol

The encrustation of indwelling catheters

Br J Urol

The characteristics and management of patients with recurrent blockage of long-term urinary catheters

J Adv Nursing

Long-term catherisation of the bladder: prevalence and morbidity

Br J Urol

Infection of catheterised patients: bacterial colonisation of encrusted Foley catheters shown by scanning electron microscopy

Urol Res

Proteus mirabilis biofilms and the encrustation of urethral catheters

Urol Res

Cited by (73)

The roles of intracellular and extracellular calcium in Bacillus subtilis biofilms

An antimicrobial impregnated urinary catheter that reduces mineral encrustation and prevents colonisation by multi-drug resistant organisms for up to 12 weeks

In vitro study on infectious ureteral encrustation resistance of Cu-bearing stainless steel

From Catheter to Kidney Stone: The Uropathogenic Lifestyle of Proteus mirabilis

Bioactive biomaterials for controlling biofilms

Rapid determination of Proteus mirabilis susceptibility to antibiotics using infrared spectroscopy in tandem with random forest

Original articleEncrustation of indwelling urethral catheters by Proteus mirabilis biofilms growing in human urine

Abstract

J Urol

J Urol

The problem of catheter encrustation

Can Med Assoc J

Catheter encrustation by struvite

Br J Urol

The encrustation of indwelling catheters

Br J Urol

The characteristics and management of patients with recurrent blockage of long-term urinary catheters

J Adv Nursing

Long-term catherisation of the bladder: prevalence and morbidity

Br J Urol

Infection of catheterised patients: bacterial colonisation of encrusted Foley catheters shown by scanning electron microscopy

Urol Res

Proteus mirabilis biofilms and the encrustation of urethral catheters

Urol Res

Original article
Encrustation of indwelling urethral catheters by Proteus mirabilis biofilms growing in human urine