Observations on the development of the crystalline bacterial biofilms that encrust and block Foley catheters.

The care of many patients undergoing long-term bladder catheterisation is complicated when the flow of urine through the catheter is blocked by encrustation. The problem results from infection by urease-producing bacteria, especially Proteus mirabilis, and the subsequent formation of crystalline bio...

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Published in:Journal of Hospital Infection Vol. 69; no. 4; pp. 350 - 361
Main Authors: Stickler DJ, Morgan SD
Format: research Journal Article
Published: W B Saunders Aug2008
Online Access:View this record in EBSCOhost
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      jtl: Journal of Hospital Infection
      issn: 01956701
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      dt: Aug2008
      vid: 69
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      pub: W B Saunders
      place: Philadelphia, Pennsylvania
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        105680786
        2010031669
        10.1016/j.jhin.2008.04.031
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        atl: Observations on the development of the crystalline bacterial biofilms that encrust and block Foley catheters.
      aug:
        au:
          Stickler DJ
          Morgan SD
        affil: Cardiff School of Biosciences, Cardiff University, Cardiff CF10 3TL, UK; stickler@cardiff.ac.uk
      sug:
        subj:
          Biofilms
          Catheters
          Proteus Physiology
          Urinary Catheterization
          Hydrogen-Ion Concentration
          Microscopy, Electron, Scanning
          Phosphates Analysis
          Proteus Metabolism
          Proteus
          Spectrometry, X-Ray Emission
          Urine Microbiology
          Urine
          Human
      ab: The care of many patients undergoing long-term bladder catheterisation is complicated when the flow of urine through the catheter is blocked by encrustation. The problem results from infection by urease-producing bacteria, especially Proteus mirabilis, and the subsequent formation of crystalline biofilms on the catheter. The aim of this study was to discover how P. mirabilis initiates the development of these crystalline biofilms. The early stages in the formation of the biofilms were observed on a range of Foley catheters in a laboratory model of the catheterised bladder. Scanning electron micrographs revealed that when all-silicone, silicone-coated latex, hydrogel-coated latex, hydrogel/silver-coated latex and nitrofurazone silicone catheters were inserted into bladder models containing P. mirabilis and alkaline urine, their surfaces were rapidly coated with a microcrystalline foundation layer. X-ray microanalysis showed that this material was composed of calcium phosphate. Bacterial colonisation of the foundation layer followed and by 18h the catheters were encrusted by densely populated crystalline P. mirabilis biofilms. These observations have important implications for the development of encrustation-resistant catheters. In the case of silver catheters for example, bacterial cells can attach to the crystalline foundation layer and continue to grow, protected from contact with the underlying silver. If antimicrobials are to be incorporated into catheters to prevent encrustation, it is important that they diffuse into the urine and prevent the rise in pH that triggers crystal formation.
      pubtype: Academic Journal
      doctype:
        research
        Journal Article
      ougenre: Article
    language: English
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