Hostname: page-component-f554764f5-sl7kg Total loading time: 0 Render date: 2025-04-13T19:14:09.970Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of the Antimicrobial Efficacy of Urinary Catheters Impregnated With Antiseptics in an In Vitro Urinary Tract Model

Published online by Cambridge University Press:  02 January 2015

Trupti A. Gaonkar ,
Lester A. Sampath  and
Shanta M. Modak
Trupti A. Gaonkar
Affiliation:
Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
Lester A. Sampath
Affiliation:
Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
Shanta M. Modak*
Affiliation:
Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
*
Department of Surgery, College of Physicians and Surgeons, Columbia University, 650 West, 168th Street, New York, NY 10032
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To evaluate the long-term efficacy of urinary Foley catheters (latex and silicone) impregnated with (1) chlorhexidine and silver sulfadiazine (CXS) and (2) chlorhexidine, silver sulfadiazine, and triclosan (CXST) in inhibiting extra-luminal bacterial adherence and to compare their efficacy with that of silver hydrogel latex (SH) and nitrofurazone-treated silicone (NF) catheters.

Design:

The antimicrobial spectrum of these catheters was evaluated using a zone of inhibition assay. A novel in vitro urinary tract model was developed to study the potential in vivo efficacy of antimicrobial catheters in preventing extraluminal bacterial colonization. The “meatus” was inoculated daily with Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Enterococcus faecalis, Pseudomonas aeruginosa, and Candida albicans. The “bladder” portion of the model was cultured daily to determine bacterial growth.

Results:

Both CXS and CXST catheters had a broader antimicrobial spectrum than SH and NF catheters. In the in vitro model, CXST latex and silicone catheters exhibited significantly better efficacy (3 to 25 days) against uropathogens, compared with CXS (1 to 14 days) and control (0 to 5 days) catheters (P = .01). CXST latex catheters exhibited significantly longer protection against Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, and Pseudomonas aeruginosa, compared with SH catheters (P = .01). CXST silicone catheters resisted colonization with Staphylococcus aureus and Staphylococcus epidermidis for a significantly longer period (23 to 24 days) than did NF catheters (9 to 11 days) (P = .01).

Conclusion:

Catheters impregnated with synergistic combinations of chlorhexidine, silver sulfadiazine, and triclosan exhibited broad-spectrum, long-term resistance against microbial colonization on their outer surfaces (Infect Control Hosp Epidemiol 2003;24:506-513)

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 7 , July 2003 , pp. 506 - 513
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1.Warren, JW. Catheter-associated urinary tract infection. Infect Dis Clin North Am 1987;1:823–854.CrossRefGoogle Scholar
2.Kass, EH, Schneiderman, LJ. Entry of bacteria into the urinary tract of patients with inlying catheters. N Engl J Med 1957;256:556–557.CrossRefGoogle ScholarPubMed
3.Garibaldi, RA, Burke, JP, Dickman, ML, Smith, CB. Factors predisposing to bacteriuria during indwelling urethral catheters. N Engl J Med 1974;291:215–219.CrossRefGoogle Scholar
4.Kunin, CM, McCormack, RC. Prevention of catheter-induced urinary tract infections by sterile closed drainage. N Engl J Med 1966;274:1155–1161.CrossRefGoogle ScholarPubMed
5.Garibaldi, RA, Burke, JP, Britt, MR, Miller, WA, Smith, CB. Meatal colonization and catheter-associated bacteriuria. N Engl J Med 1980;303:316–318.CrossRefGoogle ScholarPubMed
6.Tambyah, PA, Halvorson, KT, Maki, DG. A prospective study of pathogenesis of catheter-associated urinary tract infections. Mayo Clin Proc 1999;74:131–136.CrossRefGoogle ScholarPubMed
7.Butler, HK, Kunin, CM. Evaluation of polymyxin catheter lubricant and impregnated catheters. J Urol 1968;100:560–566.CrossRefGoogle ScholarPubMed
8.Burke, JP, Garibaldi, RA, Britt, MR, Jacobson, JA, Conti, M, Ailing, DW. Prevention of catheter-associated urinary tract infection: efficacy of daily meatal care regimens. Am J Med 1981;70:655–658.CrossRefGoogle ScholarPubMed
9.Webster, J, Hood, RH, Burridge, CA, Doidge, M, Phillips, M, George, N. Water or antiseptic for periurethral cleaning before urinary catheterization: a randomized controlled trial. Am J Infect Control 2001;29:389–394.CrossRefGoogle ScholarPubMed
10.Leidberg, H, Lundeberg, T. Silver alloy coated catheters reduce catheter-associated bacteriuria. Br J Urol 1990;65:379–381.CrossRefGoogle Scholar
11.Johnson, JR, Berggren, , Conway, AJ. Activity of nitrofurazone matrix catheter against catheter-associated uropathogens. Antimicrob Agents Chemother 1993;37:2033–2036.CrossRefGoogle ScholarPubMed
12.Johnson, JR, Roberts, PL, Olsen, R, Moyer, K, Stamm, WE. Prevention of catheter-associated urinary tract infections with silver oxide-coated urinary catheter: clinical and microbiological correlates. J Infect Dis 1990;162:1145–1150.CrossRefGoogle Scholar
13.Riley, DK, Classen, DC, Stevens, E, Burke, JP. A large randomized clinical trial of a silver-impregnated urinary catheter: lack of efficacy and staphylococcal superinfection. Am J Med 1995;98:349–356.CrossRefGoogle ScholarPubMed
14.Thibon, P, Coutour, XL, Leroyer, R, Fabry, J. Randomized multi-centre trial of the effect of catheter coated with hydrogel and silver salts on the incidence of hospital-acquired urinary infections. J Hosp Infect 2000;45:117–124.CrossRefGoogle Scholar
15.Johnson, JR, Delavari, P, Azar, M. Activities of a nitrofurazone-containing urinary catheter and a silver hydrogel catheter against multidrug-resistant bacteria characteristic of catheter-associated urinary tract infection. Antimicrob Agents Chemother 1999;43:2990–2995.CrossRefGoogle Scholar
16.Maki, DG, Knasinski, V, Halvorson, KT, Tambyah, PA, Holcomb, RG. A prospective, randomized, investigator-blinded trial of a novel nitrofura-zone-impregnated urinary catheter. Infect Control Hosp Epidemiol 1997;18(suppl):50. Abstract.Google Scholar
17.Tambe, SM, Sampath, L, Modak, SM. In vitro evaluation of the risk of developing bacterial resistance to antiseptics and antibiotics used in medical devices. J Antimicrob Chemother 2001;47:589–598.CrossRefGoogle ScholarPubMed
18.Modak, SM, Sampath, L. Development and evaluation of a new polyurethane central venous antiseptic catheter: reducing central venous catheter infections. Complications in Surgery 1992;11:23–29.Google Scholar
19.Bach, A. Clinical studies on the use of antibiotics and antiseptic bonded catheters to prevent catheter related infection. International Journal of Medical Microbiology, Virology, and Parasitology 1995;283:208–214.Google ScholarPubMed
20.Collin, GR. Decreasing catheter colonization through use of an antiseptic-impregnated catheter: a continuous quality improvement project. Chest 1999;115:1632–1640.CrossRefGoogle ScholarPubMed
21.Maki, DG, Stolz, SM, Wheeler, S, Mermel, LA. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter: a randomized controlled trial. Ann Intern Med 1997;127:257–266.CrossRefGoogle ScholarPubMed
22.Dent, L, Modak, SM, Sampath, L, Oluwole, SF, Hardy, MA. Evaluation of an infection-resistant silver-chlorhexidine-impregnated PTFE soft tissue patch. Surgical Forum 1992;43:70–72.Google Scholar
23.Kim, CY, Kumar, A, Sampath, L, Sokol, DVM, Modak, SM. Evaluation of an antimicrobial-impregnated continuous ambulatory peritoneal dialysis catheter for infection control in rats. Am J Kidney Dis 2002;39:165–173.CrossRefGoogle ScholarPubMed
24.Modak, SM, Fox, CL Jr. Binding of silver sulfadiazine to the cellular components of Pseudomonas aeruginosa. Biochem Pharmacol 1973;22:2391–2404.CrossRefGoogle Scholar
25.Sampath, LA, Choudhury, N, Caraos, L, Modak, SM. Infection resistance of surface modified catheterization with either short-lived or prolonged activity. J Hosp Infect 1995;30:201–210.CrossRefGoogle ScholarPubMed
26.Bratton, AC, Marshall, EK. A new coupling component for sulphonamide determination. J Biol Chem 1939;128:537–550.CrossRefGoogle Scholar
27.Russell, AD. Chlorhexidine: antibacterial action and bacterial resistance. Infection 1986;14:212–215.CrossRefGoogle ScholarPubMed
28.Hugo, WB. Disinfection mechanisms. In: Russell, AD, Hugo, WB, Ayliffe, GAJ, eds. Principles and Practice of Disinfection, Preservation and Sterilization. Oxford: Blackwell Scientific Publication; 1982:158–185.Google Scholar
29.Meincke, BE, Kranz, RG, Lynch, DL. Effect of irgasan on bacterial growth and adsorption into the cell wall. Microbios 1980;28:133–147.Google ScholarPubMed
30.Sastzu, M, Shimizu, K, Noguchi, N, Kono, M. Triclosan-resistant Staphylococcus aureus. Lancet 1993;341:756.CrossRefGoogle Scholar
31.McMurry, LM, Oethinger, M, Levy, SB. Triclosan targets lipid synthesis. Nature 1998;394:531–532.CrossRefGoogle ScholarPubMed
32.Denton, GW. Chlorhexidine. In: Block, SS, ed. Disinfection, Sterilization and Preservation, 4th ed. Philadelphia: Lea and Febiger; 1991:274–289.Google Scholar
33.Modak, SH, Fox, CL. Synergistic action of silver sulfadiazine and sodium piperacillin on resistant Pseudomonas aeruginosa in vitro and in experimental burn wound infections. J Trauma 1985;25:27–31.CrossRefGoogle ScholarPubMed
34.Whalen, RL, Cai, C, Thompson, LM, Sarrasin, MJ, Dempsey, DJ, Bowen, MA. An infection inhibiting urinary catheter material. ASAIO J 1997;43:M842–M847.CrossRefGoogle ScholarPubMed
35.Greenfeld, JI, Sampath, L, Popilskis, SJ, Brunnert, SR, Stylianos, S, Modak, S. Decreased bacterial adherence and biofilm formation on chlorhexidine and silver sulfadiazine-impregnated central venous catheters implanted in swine. Crit Care Med 1995;23:894–900.CrossRefGoogle ScholarPubMed
36.Sampath, L, Sabrio, DV, Yaron, I, Modak, S. Safety and efficacy of an improved antiseptic catheter impregnated intraluminally with chlorhexidine. Journal of Infusion Nursing 2001;24:395–403.CrossRefGoogle ScholarPubMed
37.Bhargava, HN, Leonard, PA. Triclosan: applications and safety. Am J Infect Control 1996;24:209–218.CrossRefGoogle ScholarPubMed
38.Desalva, SJ, Kong, BM, Lin, YJ. Triclosan: a safety profile. American Journal of Dentistry 1989;2:185–196.Google ScholarPubMed
39.Saint, S, Elmore, JG, Sullivan, SD, Emerson, SS, Koepsell, TD. The efficacy of silver alloy-coated urinary catheter in preventing urinary tract infection: a meta-analysis. Am J Med 1998;105:236–241.CrossRefGoogle ScholarPubMed
40.Maki, DG, Knasinski, V, Halvorson, K, Tambyah, PA. A novel silver-hydrogel impregnated indwelling urinary catheter reduces catheter-associated urinary tract infections: a prospective double-blind trial. Infect Control Hosp Epidemiol 1998;19:682.Google Scholar
41.Darouiche, RO, Safar, H, Raad, II. In vitro efficacy of antimicrobial-coated bladder catheters in inhibiting bacterial migration along catheter surface. J Infect Dis 1997;176:1109–1112.CrossRefGoogle ScholarPubMed