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首页> 外文会议>World biomaterials congress >Efficacy of antimicrobial impregnated urinary catheter in thwarting foreign body associated urinary tract infections caused by Pseudomonas aeruginosa
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Efficacy of antimicrobial impregnated urinary catheter in thwarting foreign body associated urinary tract infections caused by Pseudomonas aeruginosa

机译：抗菌浸渍导尿管对绿脓杆菌引起的异物相关尿路感染的抑制作用

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Introduction: Catheter associated urinary tract infections (CAUTIs) are rising exponentially around the globe; especially in intensive care units. The formation of biofilm on the surface of an indwelling urinary catheter (UC) marks the onset of CAUTI. Treatment of CAUTI/eradication of biofilm poses an intricate challenge to clinicians and researchers since bacteria within biofilm have increased protection against host immune response and resistance to antimicrobials. Biofilm-associated bacteria on the surface of UC produce quorum sensing (QS) signal molecules which regulate the expression of genes required for biofilm formation. Attenuation of QS, which in turn regulates biofilm production, seems to be a novel approach to curb CAUTI. The present study was thus designed with a preventive strategy to generate a biomaterial by impregnating a silicone UC with combination of azithromycin (AZM) and ciprofloxacin (CIP) and testing its efficacy in-vitro against Pseudomonas aeruginosa. Materials and Methods: Medical grade silicone tubing (0.30mm × 0.64mm) was impregnated with antimicrobials: 3% CIP and 6% AZM. In-vitro efficacy was assessed for control and AZM-CIP impregnated UC against P. aeruginosa standard strain PAO1 using serial plate transfer test (SPTT), in-vitro biofilm colonization, durability test, scanning electron microscopy (SEM) to visualise biofilm and shelf-life test. Results and Discussion: SPTT of AZM-CIP impregnated UC revealed prominent zones of inhibition (＞ 30mm) against P. aenjginosa PAO1 during testing period of one month and no bacterial growth was observed around or under the UC. These results indicate prolonged antimicrobial activity of these catheters with sustained diffusion of drugs and absence of resistance development since no bacteria was found attached to catheters following continuous exposure to heavy inoculum of P. aenjginosa. AZM-CIP impregnated UC showed complete inhibition of bacterial colonization and biofilm formation after 24h exposure to P. aenjginosa PAO1. These findings suggest anti-adherence activity of catheters. AZM-CIP impregnated UC were tested for durability by dipping in sterile human urine for 4 weeks simulating biological conditions. The results showed significant decline in biofilm formation over 4 weeks suggesting longer durability. These findings were further confirmed by SEM which showed limited bacterial cells within disrupted biofilm on the surface of antimicrobial impregnated UC as compared with fully grown intact biofilm on the surface of control catheters. Additionally, AZM-CIP impregnated UC showed complete inhibition of biofilm formation at quarterly intervals displaying stable real-time shelf life for one year. Conclusion: AZM-CIP impregnated UC demonstrated prolonged duration of antimicrobial and antibiofilm activity. The present study bring out the fact that synergistic combination of currently available antibiotics AZM and CIP may be usefully applied to generate a biomaterial by impregnating these drugs into a UC to prevent bacterial colonization and biofilm formation. Such a catheter would be beneficial in clinical situations, especially in long-term foreign body associated urinary tract infections.
机译：简介：导管相关性尿路感染（CAUTI）在全球范围内呈指数增长。特别是在重症监护室。在留置导尿管（UC）表面上形成生物膜标志着CAUTI的发作。 CAUTI的治疗/根除生物膜对临床医生和研究人员提出了复杂的挑战，因为生物膜中的细菌增强了对宿主免疫反应和抗微生物剂的保护作用。 UC表面上与生物膜相关的细菌产生群体感应（QS）信号分子，该信号分子调节生物膜形成所需基因的表达。 QS的衰减反过来调节了生物膜的生产，似乎是遏制CAUTI的一种新颖方法。因此，本研究设计了一种预防策略，可通过将阿奇霉素（AZM）和环丙沙星（CIP）的组合浸入有机硅UC并体外测试其对抗铜绿假单胞菌的功效来产生生物材料。材料和方法：将医用级硅胶管（0.30mm×0.64mm）浸入抗微生物剂：3％CIP和6％AZM。使用串行平板转移试验（SPTT），体外生物膜定植，耐久性试验，扫描电子显微镜（SEM）评估对照和AZM-CIP浸渍铜绿假单胞菌标准菌株PAO1的UC对对照的体外功效。寿命测试。结果与讨论：AZM-CIP浸渍的UC的SPTT在一个月的测试期间显示出对金黄色葡萄球菌PAO1的显着抑制区域（＞ 30mm），并且在UC周围或下方均未观察到细菌生长。这些结果表明，在持续暴露于金黄色假单胞菌的重接种物中后，未发现细菌附着于导管，这些导管具有延长的抗菌活性，并具有药物的持续扩散和无耐药性的发展。 AZM-CIP浸渍的UC在暴露于铜绿假单胞菌PAO1 24小时后显示出对细菌定植和生物膜形成的完全抑制。这些发现表明导管的抗粘附活性。通过将AZM-CIP浸渍的UC浸入无菌人尿中4周以模拟生物学条件，从而测试其耐久性。结果表明，在4周内生物膜形成显着下降，表明更长的耐久性。 SEM进一步证实了这些发现，与对照导管表面上完全生长的完整生物膜相比，SEM显示抗微生物浸渍的UC表面上破坏的生物膜内的细菌细胞有限。此外，AZM-CIP浸渍的UC每季度间隔完全抑制生物膜的形成，显示稳定的实时保质期为一年。结论：AZM-CIP浸渍的UC表现出延长的抗微生物和抗生物膜活性的持续时间。本研究提出了这样一个事实，即可以通过将现有药物AZM和CIP的协同组合浸入UC来防止细菌定植和生物膜形成，从而有效地用于产生生物材料。这样的导管在临床情况下将是有益的，特别是在与异物有关的长期尿路感染中。

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