Clinical complications of urinary catheters caused by crystalline biofilms: something needs to be done

Abstract

Abstract. Stickler DJ (Cardiff University, Cardiff, UK). Clinical complications of urinary catheters caused by crystalline biofilms: something needs to be done. (Review). J Intern Med 2014; 276: 120-129.This review is largely based on a previous paper published in the journal Spinal Cord. The care of many patients undergoing long-term bladder catheterization is complicated by encrustation and blockage of their Foley catheters. This problem stems from infection by urease-producing bacteria, particularly Proteus mirabilis. These organisms colonize the catheter forming an extensive biofilm; they also generate ammonia from urea, thus elevating the pH of urine. As the pH rises, crystals of calcium and magnesium phosphates precipitate in the urine and in the catheter biofilm. The continued development of this crystalline biofilm blocks the flow of urine through the catheter. Urine then either leaks along the outside of the catheter and the patient becomes incontinent or is retained causing painful distension of the bladder and reflux of urine to the kidneys. The process of crystal deposition can also initiate stone formation. Most patients suffering from recurrent catheter encrustation develop bladder stones. P. mirabilis establishes stable residence in these stones and is extremely difficult to eliminate from the catheterized urinary tract by antibiotic therapy. If blocked catheters are not identified and changed, serious symptomatic episodes of pyelonephritis, septicaemia and endotoxic shock can result. All types of Foley catheters including silver-or nitrofurazonecoated devices are vulnerable to this problem. In this review, the ways in which biofilm formation on Foley catheters is initiated by P. mirabilis will be described. The implications of understanding these mechanisms for the development of an encrustation-resistant catheter will be discussed. Finally, the way forward for the prevention and control of this problem will be considered.

Importance of biofilm in medical sciences: With special reference to uropathogens

“…Management of urinary catheter encrustation is difficult, and occurrence is both unpredictable and extremely hard to prevent with existing strategies (Trautne et al, 2004). Most often, the approach used is catheter replacement once blockage has occurred (Stickler et al, 2014). Unfortunately, such treatment is often unsuccessful with frequent recurrence of blockage evident (Mathur et al, 2006).…”

Nickel, molybdenum, and tungsten nanoparticle-dispersed alkylalkoxysilane polymer for biomaterial coating: evaluation of effects on bacterial biofilm formation and biosafety

“…For example, 10-30% of patients with bladder catheters suffer from infection every year in the US [1]. Antibiotics and biocides are therapeutically used to inhibit bacterial growth; however, they are hardly effective against biofilms, thus presenting serious problems in the medical field [2].…”

Metagenomic approach to study biofilm in medical context

“…They can directly colonize human surfaces or they colonize medical devices and contaminate patients that depend of such devices as catheters, endotracheal tubes, joint implants, breast implants and others (21)(22)(23)(24). The biofilm formed in these devices serves as a source of pathogenic microorganisms that may cause acute or chronic infections.…”