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01-09-2020 | Ciprofloxacin | Original Article

High-resolution imaging reveals microbial biofilms on patient urinary catheters despite antibiotic administration

Authors: Jennifer N. Walker, Ana L. Flores-Mireles, Aaron J. L. Lynch, Chloe Pinkner, Michael G. Caparon, Scott J. Hultgren, Alana Desai

Published in: World Journal of Urology | Issue 9/2020

Abstract

Purpose

Catheter-associated urinary tract infections (CAUTIs) are a significant cause of morbidity worldwide, as they account for 40% of all hospital-associated infections. Microbial biofilm formation on urinary catheters (UCs) limits antibiotic efficacy, making CAUTI extremely difficult to treat. To gain insight into the spatiotemporal microbe interactions on the catheter surface we sought to determine how the presence or absence of bacteriuria prior to catheterization affects the organism that ultimately forms a biofilm on the UC and how long after catheterization they emerge.

Methods

Thirty UCs were collected from patients who received a urine culture prior to catheterization, a UC, and antibiotics as part of standard of care. Immunofluorescence imaging and scanning electron microscopy were used to visualize patient UCs.

Results

Most patients did not have bacteria in their urine (based on standard urinalysis) prior to catheterization, yet microbes were detected on the majority of UCs, even with dwell times of < 3 days. The most frequently identified microbes were Staphylococcus epidermidis, Enterococcus faecalis, and Escherichia coli.

Conclusions

This study indicates that despite patients having negative urine cultures and receiving antibiotics prior to catheter placement, microbes, including uropathogens associated with causing CAUTI, could be readily detected on UCs with short dwell times. This suggests that a potential microbial catheter reservoir can form soon after placement, even in the presence of antibiotics, which may serve to facilitate the development of CAUTI. Thus, removing and/or replacing UCs as soon as possible is of critical importance to reduce the risk of developing CAUTI.

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Rousseau M, Goh HM, Holec S, Albert ML, Williams RB, Ingersoll MA et al (2016) Bladder catheterization increases susceptibility to infection that can be prevented by prophylactic antibiotic treatment. JCI Insight 1(15):e88178. https://doi.org/10.1172/jci.insight.88178CrossRefPubMedPubMedCentral

Nicolle LE (2012) Urinary catheter-associated infections. Infect Dis Clin N Am 26(1):13–27. https://doi.org/10.1016/j.idc.2011.09.009CrossRef

Cope M, Cevallos ME, Cadle RM, Darouiche RO, Musher DM, Trautner BW (2009) Inappropriate treatment of catheter-associated asymptomatic bacteriuria in a tertiary care hospital. Clin Infect Dis 48(9):1182–1188. https://doi.org/10.1086/597403CrossRefPubMed

Trautner BW, Darouiche RO (2004) Catheter-associated infections: pathogenesis affects prevention. Arch Intern Med 164(8):842–850. https://doi.org/10.1001/archinte.164.8.842CrossRefPubMedPubMedCentral

Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ (2015) Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol 13(5):269–284. https://doi.org/10.1038/nrmicro3432CrossRefPubMedPubMedCentral

Babich T, Zusman O, Elbaz M, Ben-Zvi H, Paul M, Leibovici L et al (2017) Empirical antibiotic treatment does not improve outcomes in catheter-associated urinary tract infection: prospective cohort study. Clin Infect Dis 65(11):1799–1805. https://doi.org/10.1093/cid/cix680CrossRefPubMed

Darouiche RO (2001) Device-associated infections: a macroproblem that starts with microadherence. Clin Infect Dis 33(9):1567–1572. https://doi.org/10.1086/323130CrossRefPubMed

Tambyah PA, Knasinski V, Maki DG (2002) The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 23(1):27–31. https://doi.org/10.1086/501964CrossRefPubMed

Meddings J, Rogers MA, Krein SL, Fakih MG, Olmsted RN, Saint S (2014) Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf 23(4):277–289. https://doi.org/10.1136/bmjqs-2012-001774CrossRefPubMed

10.

Chenoweth CE, Gould CV, Saint S (2014) Diagnosis, management, and prevention of catheter-associated urinary tract infections. Infect Dis Clin 28(1):105–119. https://doi.org/10.1016/j.idc.2013.09.002CrossRef

11.

Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC et al (2010) Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 50(5):625–663. https://doi.org/10.1086/650482CrossRefPubMed

12.

Bjarnsholt T, Ciofu O, Molin S, Givskov M, Hoiby N (2013) Applying insights from biofilm biology to drug development—can a new approach be developed? Nat Rev Drug Discov 12(10):791–808. https://doi.org/10.1038/nrd4000CrossRefPubMed

13.

The Center for Disease Control and Prevention (2019) Urinary tract infection (catheter- associated urinary tract infection [CAUTI] and non-catheter-associated urinary tract infection [UTI]) and other urinary system infection [USI]) events. Device-associated Module. UTI. 7.1–7.17 National Healthcare Safety Network (NHSN) Patient Safety Component Manual. https://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf

14.

Bonkat G, Bruyere F, Cai T, Geerlings SE, Koves B, Schubert S, Wagenlehner F, Mezei T, Pilatz A, Pradere B, Veeratterapillary R (2018) EAU Guidelines on urologic infections. EAU Guidelines Office, Arnhem. http://uroweb.org/guidelines/compilations-of-all-guidelines/

15.

Trautner BW (2010) Management of catheter-associated urinary tract infection. Curr Opin Infect Dis 23(1):76–82. https://doi.org/10.1097/QCO.0b013e328334dda8CrossRefPubMedPubMedCentral

16.

Grabe M, Botto H, Çek M, Naber KG, Pickard RS, Tenke P, Wagenlehner F, Wullt B (2011) Guidelines on urological infections. European Association of Urology (EAU), Arnhem

17.

Wagenlehner FM, Cek M, Naber KG, Kiyota H, Bjerklund-Johansen TE (2012) Epidemiology, treatment and prevention of healthcare-associated urinary tract infections. World J Urol 30(1):59–67. https://doi.org/10.1007/s00345-011-0757-1CrossRefPubMed

18.

Flores-Mireles AL, Walker JN, Bauman TM, Potretzke AM, Schreiber HL, Park AM et al (2016) Fibrinogen release and deposition on urinary catheters placed during urological procedures. J Urol. https://doi.org/10.1016/j.juro.2016.01.100CrossRefPubMedPubMedCentral

19.

Walker JN, Flores-Mireles AL, Pinkner CL, Schreiber HL, Joens MS, Park AM et al (2017) Catheterization alters bladder ecology to potentiate Staphylococcus aureus infection of the urinary tract. Proc Natl Acad Sci USA. https://doi.org/10.1073/pnas.1707572114CrossRefPubMed

20.

Walker JN, Pinkner CL, Lynch AJL, Ortbal S, Pinkner JS, Hultgren SJ et al (2019) Deposition of host matrix proteins on breast implant surfaces facilitates Staphylococcus epidermidis biofilm formation: in vitro analysis. Aesthet Surg J. https://doi.org/10.1093/asj/sjz099CrossRefPubMed

21.

Flores-Mireles AL, Walker JN, Potretzke A, Schreiber HL, Pinkner JS, Bauman TM et al (2016) Antibody-based therapy for enterococcal catheter-associated urinary tract infections. Biology. https://doi.org/10.1128/mBio.01653-16CrossRef

22.

Brubaker L, Wolfe AJ (2017) The female urinary microbiota, urinary health and common urinary disorders. Ann Transl Med 5(2):34. https://doi.org/10.21037/atm.2016.11.62CrossRefPubMedPubMedCentral

23.

Tambyah PA, Maki DG (2000) Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients. Arch Intern Med 160(5):678–682PubMed

24.

Andersson DI, Hughes D (2014) Microbiological effects of sublethal levels of antibiotics. Nat Rev Microbiol 12(7):465–478. https://doi.org/10.1038/nrmicro3270CrossRefPubMed

Title: High-resolution imaging reveals microbial biofilms on patient urinary catheters despite antibiotic administration
Authors: Jennifer N. Walker
Ana L. Flores-Mireles
Aaron J. L. Lynch
Chloe Pinkner
Michael G. Caparon
Scott J. Hultgren
Alana Desai
Publication date: 01-09-2020
Publisher: Springer Berlin Heidelberg
Keywords: Ciprofloxacin
Antibiotic
Cefazolin
Pseudomonas Aeruginosa
Published in: World Journal of Urology / Issue 9/2020
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-019-03027-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

High-resolution imaging reveals microbial biofilms on patient urinary catheters despite antibiotic administration

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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