Biofilms on indwelling urologic devices: Microbes and antimicrobial management prospect

Abstract

Background:Biofilms (BFs) are a potential source of highly resistant infections, frequently formed on devicesand pose problems for management.Aim:This study was to develop rational approach for prevention of indwelling urologic device associated biofilm colonization.Subjects and Methods:From randomly selected patients visiting Department of Urology of a tertiary hospital in India 150 uro catheters and 31 used ureteric stents, in-situ for > 30, were collected aseptically. The organisms were isolated and identified from washed devices dipped in broth. Evidence of bacteriuria in each case was checked by semi-quantitative method of urine culture, on day 0 and 14 of device use. The BF statuses of the device-adhered organisms were confirmed by modified method of Christensen. The antibiotic susceptibility was determined by disc diffusion method. Data were analyzed using the Graphpad Prism version 5 statistical software.Results:Both single and multi-species BFs were formed on catheters, whereas mono-bacterial BFs were exclusive on stents. Predominant organisms were Pseudomonas aeruginosa (30.67%,69/225,) followed by Staphylococcus aureus (15.11%, 34/225), Escherichia coli (13.78%, 31/225), Klebsiella pneumoniae (12%, 27/225), Staphylococcus epidermidis (8.44%, 19/225). Of all strains, (89.33%, 201/225) were found to be BF positive and their colonizations were early indicated by the presence of insignificant bacteriuria in follow-up urine samples. All BF isolates were resistant to at least three antibiotics.Conclusions:BF colonization was almost inevitable in prolonged used urinary devices and the most frequent organisms were Pseudomonas, Staphylococcus, and Escherichia spp. Their colonizations usually were indicated by insignificant bacteriuria from follow-up samples. Such BF dislodged organisms were multidrug resistant and could be a source of disseminated infection, yet were in-vitro preventable by many drugs.

Staphylococcus aureus biofilms: recent developments in biofilm dispersal

“…The infections that result are quite diverse, and can include acute infections, such as bacteremia and skin abscesses, that are generally caused by planktonic cells through the production of secreted toxins and exo-enzymes (Gordon and Lowy, 2008 ). In contrast, chronic infections are associated with a biofilm mode of growth where S. aureus can attach and persist on host tissues, such as bone and heart valves, to cause osteomyelitis and endocarditis respectively, or on implanted materials, such as catheters, prosthetic joints, and pace makers (Parsek and Singh, 2003 ; Kiedrowski and Horswill, 2011 ; Barrett and Atkins, 2014 ; Chatterjee et al, 2014 ). Implanted materials become coated with host proteins upon insertion, and the matrix-binding proteins on the surface of S. aureus facilitate attachment to these proteins and development of a biofilm (Cheung and Fischetti, 1990 ; Francois et al, 1996 ).…”

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

“…This procedure most likely increases the risk of pneumonia by impairing respiratory tract clearance mechanisms, providing a substrate for the formation of bacterium-containing biofilms, and/or allowing the accumulation of bacterium-carrying oropharyngeal secretions around the endotracheal tube cuff (120). Insertion of a catheter is another means of initiating K. pneumoniae infection, where the implant allows a point of entry into the urinary tract as well as a substrate on which K. pneumoniae can form a biofilm (75,121).…”

Risks of forgotten double-J ureteric stents after ureterorenoscopic lithotripsy in Taiwan: a nationwide population-based study

“…3 Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan. 4 Department of Education and Research, Taipei City Hospital, Taipei, Taiwan. 5 Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.…”

“…One of the most devastating complications is the unexpectedly delayed-removal of DJs, also known as forgotten DJs 2,3 . Urinary tract infection and encrustations are common symptoms related to forgotten DJs, and occasionally atrophy develops in the affected kidney due to long-term in-stent obstruction 4,5 . Since the management of forgotten DJs is challenging and requires additional endoscopic or even open procedures, there are studies that have focused on identifying the risk factors associated with forgotten DJs 2,6 .…”