1887

Abstract

The problem of catheter encrustation stems from infection by urease-producing bacteria. These organisms generate ammonia from urea, elevate the pH of urine and cause crystals of calcium and magnesium phosphates to form in the urine and the biofilm that develops on the catheter. In this study, a laboratory model was used to compare the ability of 12 urease-positive species of urinary tract pathogens to encrust and block catheters. , and were able to raise the urinary pH above 8.3 and produce catheter-blocking crystalline biofilms within 40 h. and elevated the pH of urine to 7.4 and 6.9, respectively, and caused some crystal deposition in the biofilms but did not block catheters in the 96 h experimental period. Isolates of , , , , and were only capable of raising the pH of urine to a maximum of 6.4 and failed to cause crystal deposition in the biofilm. The most effective way to prevent catheter encrustation was shown to be diluting urine and increasing its citrate concentration. This strategy raises the nucleation pH (pH) at which calcium and magnesium phosphates crystallize from urine. Increasing the fluid intake of a healthy volunteer with citrated drinks resulted in urine with a pH of >8.0 in which catheter encrustation was inhibited. It is suggested that this dietary strategy will be an effective means of controlling catheter encrustation, whichever bacterial species is causing the problem.

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2009-10-01
2024-03-29
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References

  1. Burr R. G., Nuseibeh I. M. 1997; Urinary catheter blockage depends on urine pH, calcium and rate of flow. Spinal Cord 35:521–525 [CrossRef]
    [Google Scholar]
  2. Choong S. K. S., Hallson P., Whitfield H. N., Fry C. H. 1999; The physicochemical basis of urinary catheter encrustation. BJU Int 83:770–775
    [Google Scholar]
  3. Choong S. K. S., Wood S., Fry C. H., Whitfield H. N. 2001; Catheter associated urinary tract infection and encrustation. Int J Antimicrob Agents 17:305–310 [CrossRef]
    [Google Scholar]
  4. Creno R. J., Wenk R. E., Bohlig P. 1970; Automated micromeasurement of urea using urease and the Berthelot reaction. Am J Clin Pathol 54:828–832
    [Google Scholar]
  5. Griffith D. P., Musher D. M., Itin C. 1976; Urease, the primary cause of infection-induced urinary stones. Invest Urol 13:346–350
    [Google Scholar]
  6. Jones G. L., Muller C. T., O'Reilly M., Stickler D. J. 2006; Effect of triclosan on the development of bacterial biofilms by urinary tract pathogens on urinary catheters. J Antimicrob Chemother 57:266–272 [CrossRef]
    [Google Scholar]
  7. Kang D. E., Surl R. L., Haleblian G. E., Fitzsimons N. J., Borawski K. M., Preminger G. M. 2007; Long-term lemonade-based dietary manipulation in patients with hypocitraturic nephrolithiasis. J Urol 177:1358–1362 [CrossRef]
    [Google Scholar]
  8. Kohler-Ockmore J., Feneley R. C. L. 1996; Long-term catheterization of the bladder: prevalence and morbidity. Br J Urol 77:347–351 [CrossRef]
    [Google Scholar]
  9. Kunin C. M. 1989; Blockage of urinary catheters: role of microorganisms and constituents of the urine on formation of encrustations. J Clin Epidemiol 42:835–842 [CrossRef]
    [Google Scholar]
  10. Kunin C. M. 1997 Urinary Tract Infections; Detection, Prevention and Management , 5th edn. pp 226–278 Baltimore: Williams and Wilkins;
    [Google Scholar]
  11. MacLeod S. M., Stickler D. J. 2007; Species interactions in mixed-community crystalline biofilms on urinary catheters. J Med Microbiol 56:1549–1557 [CrossRef]
    [Google Scholar]
  12. Mathur S., Suller M. T. E., Stickler D. J., Feneley R. C. L. 2005; A prospective study of individuals with long-term urinary catheters colonized by Proteus sp. BJU Int 97:121–128
    [Google Scholar]
  13. Mobley H. L. T., Warren J. W. 1987; Urease-positive bacteriuria and obstruction of long-term urinary catheters. J Clin Microbiol 25:2216–2217
    [Google Scholar]
  14. Morgan S. D., Rigby D., Stickler D. J. 2009; A study of the structure of the crystalline bacterial biofilms that can encrust and block silver Foley catheters. Urol Res 37:89–93 [CrossRef]
    [Google Scholar]
  15. Morris N. S., Winters C., Stickler D. J. 1997; Which indwelling urethral catheters resist encrustation by Proteus mirabilis biofilms?. Br J Urol 80:58–63 [CrossRef]
    [Google Scholar]
  16. Morris N. S., Stickler D. J., McLean R. J. C. 1999; The development of bacterial biofilms on indwelling catheters. World J Urol 17:345–350 [CrossRef]
    [Google Scholar]
  17. Seltzer M. A., Low R. K., McDonald M., Shami G. S., Stoller M. L. 1996; Dietary manipulation with lemonade to treat hypocitraturic calcium nephrolithiasis. J Urol 156:907–909 [CrossRef]
    [Google Scholar]
  18. Stickler D. J. 2002; Susceptibility of antibiotic-resistant Gram-negative bacteria to biocides: a perspective from a study of catheter biofilms. J Appl Microbiol 92:163S–170S [CrossRef]
    [Google Scholar]
  19. Stickler D. J., Jones G. L. 2008; Reduced susceptibility of Proteus mirabilis to triclosan. Antimicrob Agents Chemother 52:991–994 [CrossRef]
    [Google Scholar]
  20. Stickler D. J., Morgan S. D. 2006; Modulation of crystalline Proteus mirabilis biofilm development on urinary catheters. J Med Microbiol 55:489–494 [CrossRef]
    [Google Scholar]
  21. Stickler D. J., Morgan S. D. 2008; Observations on the development of the crystalline bacterial biofilms that encrust and block Foley catheters. J Hosp Infect 69:350–360 [CrossRef]
    [Google Scholar]
  22. Stickler D. J., Zimakoff J. 1994; Complications of urinary tract infections associated with devices for long-term bladder management. J Hosp Infect 28:177–194 [CrossRef]
    [Google Scholar]
  23. Stickler D. J., Ganderton L., King J., Nettleton J., Winters C. 1993; Proteus mirabilis biofilms and the encrustation of urethral catheters. Urol Res 21:407–411 [CrossRef]
    [Google Scholar]
  24. Stickler D. J., Morris N. S., Moreno M. C., Sabbuba N. A. 1998; Studies on the formation of crystalline bacterial biofilms on urethral catheters. Eur J Clin Microbiol Infect Dis 17:649–652 [CrossRef]
    [Google Scholar]
  25. Stickler D. J., Morris N. S., Winters C. 1999; Simple physical model to study formation and physiology of biofilms on urethral catheters. Methods Enzymol 310:494–501
    [Google Scholar]
  26. Stickler D. J., Jones G. L., Russell A. D. 2003; Control of encrustation and blockage of Foley catheters. Lancet 361:1435–1437 [CrossRef]
    [Google Scholar]
  27. Suller M. T. E., Anthony V. J., Mathur S., Feneley R. C. L., Stickler D. J. 2005; Factors modulating the pH at which calcium and magnesium phosphates precipitate from human urine. Urol Res 33:254–260 [CrossRef]
    [Google Scholar]
  28. Wang Y. H., Grenabo L., Hedelin H., Pettersson S. 1994; The effects of sodium citrate and oral potassium citrate on urease-induced crystallization. Br J Urol 74:409–415 [CrossRef]
    [Google Scholar]
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