In Vitro Evaluation of the Efficacy of a Silver-Coated Catheter

Bacteria commonly associated with nosocomial urinary tract infections were examined in vitro for their relative adherence to latex, 100% silicone-, hydrogel-coated latex-, and hydrogel/silver-coated latex urinary catheters. Degrees of adherence within 2 h were determined with cells radiolabeled with leucine. Adherence was greatest and equivalent on silicone and latex catheters. Adherence of four strains of Escherichia coli to the hydrogel/silver-coated catheter was decreased by 50% to 99% in comparison with the other catheters. Repeat testing with strains of E. coli and Pseudomonas aeruginosa with over 50 catheters demonstrated a consistency in the inhibition. The hydrophilic coating of the catheter appeared to be primary in the decreased adherence phenomenon followed by a secondary biocidal effect of the silver ion. Received: 2 December 1995 / Accepted: 3 January 1996     

The effect of chlorhexidine and gentian violet on the adherence of <Emphasis Type="Italic">Candida</Emphasis> spp. to urinary catheters

Urinary tract infection associated with catheters is the most common infection in the hospital environment. The adherence of microorganisms to the surface is a determining factor in colonization and infection. Antiseptics such as chlorhexidine and gentian violet have been shown to be effective against yeasts, as well as having low toxicity and being low-cost. The objective of the present study was to evaluate whether prior treatment of siliconized latex urinary catheters with antiseptics reduces the adherence of yeasts. Two reference strains of C. albicans (ATCC 645448 and ATCC 90028) and six strains isolated from catheter, two each of C. albicans, C. tropicalis, and C. parapsilosis, were used. An in␣vitro study of adherence was carried out with previously treated catheters, in separate experiments of 1 h and 24 h of incubation under continued shaking. The relative hydrophobicity of the cell surface of the yeasts before and after 1 h of exposure to chlorhexidine was determined. The results demonstrated that both treatments were effective in controlling the adherence of yeast to the catheter (P < 0.0001), and that the hydrophobicity of the eight strains significantly increased after contact with chlorhexidine (P < 0.0001). These results suggest that the antimicrobial activity of chlorhexidine and gentian violet reduces the adherence of the microorganisms to the catheter.     

Disruption of the GPI Protein-Encoding Gene <Emphasis Type="Italic">IFF4</Emphasis> of <Emphasis Type="Italic">Candida</Emphasis> <Emphasis Type="Italic">albicans</Emphasis> Results in Decreased Adherence and Virulence

Candida albicans is the most important cause of systemic fungal infection in immunocompromised humans. Candidiasis is often initiated by the adherence and the colonization of inert surfaces such as peripheral venous catheters, central catheters, prosthetic cardiac valves, and other prostheses. We have studied the early stage of adherence and have shown that the disruption of C. albicans IFF4 gene encoding a GPI-anchor protein, led to a decrease of adherence of the germ tubes to plastic. Here, we demonstrated the role of the IFF4 gene in adherence to silicone catheter, as well as in virulence using a murine model of disseminated candidiasis. The iff4 Δ null mutant showed both a decrease of adherence to silicone catheter and a reduction of virulence. This work presents evidence for the importance of the IFF4 gene in host-fungal interaction.     

Vancomycin Resistance Among Strains of Staphylococcus epidermidis: Effects on Adherence to Silicone

Nosocomial device-related infections with Gram-positive cocci and their resistance to vancomycin are of increasing occurrence. We examined clinical isolates of relatively avirulent coagulase-negative staphylococci for their resistance to vancomycin and for their capabilities to adhere in vitro to medical grade silicone. Vancomycin resistance was found in 9 of 20 isolates, but there was no correlation between adherence capacity to silicone in the absence of vancomycin and vancomycin resistance for a given strain. Vancomycin in the medium, adsorbed to the surface of medical grade silicone or adsorbed on nongrowing cells, reduced adherence of representative Staphylococcus epidermidis to medical grade silicone. Received: 27 November 2000 / Accepted: 10 January 2001     

Radiopacity additives in silicone stent materials reduce in vitro bacterial adherence

In vitro adherence of the nosocomial pathogensPseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, Serratia marcescens, andCandida albicans to select radiopaque silicone compounds was lower than that observed for the base silicone (p<0.03). Except forE. coli ATCC 11775 andCandida albicans, all microorganisms showed significantly lower adherence to a silicone compound impregnated with tantalum in comparison with a silicone compound impregnated with barium sulfate (p<0.05). Surface hydrophobicity of the silicone compounds did not show a direct correlation with the concentration of radiopacity additives or with degree of bacterial adherence. Scatchard analyses of data indicated that the number of adherence sites forP. aeruginosa on the base silicone, BaSO₄-silicone, and Ta-silicone were 9.2×10⁶ per mm², 6.1×10⁶ per mm², and 3.7×10⁶ per mm² respectively. As determined by the Langmuir adsorption isotherm, the dissociation constants for adheredP. aeruginosa to the base silicone, BaSO₄-silicone, and Ta-silicone were 2.50×10³ mm⁴, 1.45×10³ mm⁴, and 6.27×10³ mm⁴ respectively.Pseudomonas aeruginosa demonstrated first order kinetics of adherence to the silicone compounds with a half saturation time of 4.15 h for the base silicone, 1.06 h for the BaSO₄-silicone, and 2.14 h for the Ta-silicone. The use of Ta-silicone stents may delay the development of ascending urinary tract infections.     

Evaluation of the Adherence of Candida Species to Urinary Catheters

Catheter-associated urinary tract infections (CAUTIs) are the most common kind of nosocomial infection. Recent years have seen a significant increase in numbers of infections caused by yeasts of the genus Candida. The adherence of a microorganism to the host surface is a decisive factor in the success of colonization and the pathogenesis of infection. The objective of this work was to evaluate the adherence of species of the genus Candida to urinary catheters. In vitro adherence to the sections of latex and silicon catheters of Candida albicans and Candida parapsilosis were studied. Adherence was measured by counting the number of adhering viable cells and the results were expressed as Colonies Forming Units per mL. The results demonstrated that the latex catheter facilitated adherence more than the silicon catheter (p < 0.01). The adherence of the C. albicans was significantly greater than C. parapsilosis on latex, but it was similar on silicon.     

Bacteriocins Pep5 and Epidermin Inhibit Staphylococcus epidermidis Adhesion to Catheters

Pep5 and epidermin bacteriocins were tested on clinical strains of Staphylococcus epidermidis and S. aureus isolated from catheter-related infections. These bacteriocins were inhibitory to several isolates at a concentration of 640 activity units mL⁻¹. The ability of bacteriocins in inhibiting adhesion of S. epidermidis to silicone catheters was evaluated. When Pep5 and epidermin were added to in vitro catheter colonization experiments, there was a significant decrease in the cell number of S. epidermidis adhered to silicone catheters. Bacteriocins used to decrease bacterial attachment to medical devices may represent a novel strategy to control catheter-related infections.     

The problem of catheter encrustation

Catheter encrustation was studied in a group of long-stay hospital patients using both latex and silicone catheters. Moisture accounted for 80% by weight of the encrusted material with both catheters. Of the dry weight 90% was composed of protein, calcium, phosphorus, magnesium and uric acid. No relationship was found between the amounts of these substances in the urine and in the encrusted material. High levels of calcium, phosphorus and magnesium were found in the encrusted material from patients infected with Proteus organisms. No direct relationship was found between the duration of catheter drainage and the degree of encrustation, and there was a variation in patient susceptibility to encrustation irrespective of the catheter material. There was significantly less encrustation associated with silicone catheters.     

Virulence factors and<Emphasis Type="Italic">in Vitro</Emphasis> adherence of<Emphasis Type="Italic">Enterococcus</Emphasis> strains to urinary catheters

The ability to adhere in vitro to urinary catheters and the presence of enterococcal virulence factors was determined in 30 Enterococcus urinary isolates (12 E. faecalis, 12 E. faecium, 3 E. casseliflavus, 3 E. gallinarum). Silicone, siliconized latex and polyvinyl chloride (PVC) were examined by sonication quantitative culture technique and scanning electron microscope. As compared to E. faecalis and E. faecium, E. casseliflavus and E. gallinarum displayed lower adhesion to all synthetic materials. All the tests performed showed higher adherence of all tested strains to siliconized latex and silicone than to PVC. Biofilmforming ability was observed in 5 E. faecalis but in none of the remaining strains. The gene coding enterococcal surface protein (Esp) was detected in 7 E. faecalis and 6 E. faecium strains. Gelatinase was found in 1 E. faecalis, 2 E. faecium and hemolysins were found in 6 E. faecalis and 1 E. faecium strains. All E. casseliflavus and E. gallinarum strainswere negative for these traits. Hydrophobic type of cell surface (measured by its affinity for n-hexadecane) was shown in a few isolates. Bacterial adherence was not significantly associated with the above pathogenic factors.     

Effects of Hydrogel/Silver Coatings on In Vitro Adhesion to Catheters of Bacteria Associated with Urinary Tract Infections

Sections of sterile all-silicone-, hydrogel/silver-all-silicone-, and hydrogel/silver-latex-Foley urinary catheters were exposed to suspensions of bacteria and Candida albicans associated with urinary tract infections. The adhesion of these microorganisms to the catheters was determined with a radiolabel–cell procedure and scanning electron microscopy. Anomalous data with the radiolabel procedure were produced with the hydrogel/silver-latex catheters for certain species. These aberrant data were related to adhesion on the untreated cut ends of the latex catheter. Radiolabel-cell-adhesion procedures that involve sections of coated materials may need to be supplemented with additional procedures such as scanning electron microscopy for valid interpretations of the data. Adhesion to the hydrogel/silver catheters by both Gram-positive- and Gram-negative bacteria most commonly associated with nosocomial urinary tract infections, including a strain of Pseudomonas aeruginosa noted for its superior adhesion capacity, was significantly lower than the adhesion to the control all-silicone catheter. Received: 21 January 2000 / Accepted: 26 February 2000     

Evaluation of Adherence,Hydrophobicity, Aggregation,and Biofilm Development of <Emphasis Type="Italic">Flavobacterium johnsoniae</Emphasis>-Like Isolates

Flavobacterium spp. isolates have been identified in diverse biofilm structures, but the mechanism of adherence has not been elucidated. The absence of conventional biofilm-associated structures such as fimbriae, pili, and flagella suggest that surface hydrophobicity, and/or autoaggregation and coaggregation may play an important role in adherence and biofilm formation. The biofilm-forming capacity of 29 Flavobacterium johnsoniae-like isolates obtained from South African aquaculture systems was assessed using microtiter plate assays. The role of hydrophobicity [salting aggregation test (SAT) and bacterial adherence to hydrocarbons (BATH) assays], autoaggregation, and coaggregation on biofilm formation by Flavobacterium spp. was also investigated, while biofilm structure was examined using flow cells and microscopy. All isolates displayed a hydrophilic nature, but showed varying levels of adherence in microtiter assays. Significant negative correlations were observed between adherence and biofilm-forming capacity in nutrient-poor medium at 26°C and BATH hydrophobicity and motility, respectively. Isolates displayed strain-to-strain variation in their autoaggregation indices and their abilities to coaggregate with various Gram-negative and Gram-positive organisms. Microcolony and/or biofilm development were observed microscopically, and flavobacterial isolates displayed stronger biofilm structures and interaction with a Vibrio spp. isolate than with an Aeromonas hydrophila isolate. The role of extracellular polysaccharides and specific outer membrane proteins will have to be examined to reveal mechanisms of adherence and coaggregation employed by biofilm-forming F. johnsoniae-like strains.     

The effects of copper additives on the quantity and cell viability of adherent Staphylococcus epidermidis in silicone implants

This in vitro study evaluated the antibacterial effect of copper additives in silicone implants. Specimens of a standard silicone material used in breast augmentation and modified copper-loaded silicone specimens were prepared and incubated in a Staphylococcus epidermidis suspension (2 h, 37°C). After the quantification of adhering staphylococci using a biofluorescence assay (Resazurin), the viability of the adhering bacterial cells was quantified by live or dead cell labeling in combination with fluorescence microscopy. In the Resazurin fluorometric quantification, a higher amount of adhering S. epidermidis cells was detected on pure silicone (4612 [2319/7540] relative fluorescence units [rfu]) than on silicone with copper additives (2701 [2158/4153] rfu). Additionally, a significantly higher amount of adhering bacterial cells (5.07% [2.03%/8.93%]) was found for pure silicone than for silicone with copper additives (1.72% [1.26%/2.32%]); (p < 0.001). Calculations from live or dead staining showed that the percentage of dead S. epidermidis cells adhered on pure silicone (52.1%) was significantly lower than on silicone with copper additives (79.7%); (p < 0.001). In vitro, silicone material with copper additives showed antibacterial effects against S. epidermidis. Copper-loaded silicone may prevent bacterial colonization, resulting in lower infection rates of silicone implants.     

Cell surface properties of two differently virulent strains of Acinetobacter baumannii isolated from a patient

The aim of this study was to unravel, by focusing on cell surface properties, the underlying virulence factors contributing to the difference in the pathogenicity observed in two Acinetobacter baumannii strains isolated from the same patient. The two strains were phenotypically different: (i) a mucoid strain (AB-M), highly virulent in a mouse model of pneumonia, and (ii) a nonmucoid strain (AB-NM), moderately virulent in the same model. The study of the cell surface properties included the microbial adhesion to solvents method, the measurement of the electrophoretic mobility of bacteria, the analysis of biofilm formation by calcofluor white staining, the adherence to silicone catheters, and scanning electron microscopy. The AB-NM strain was more hydrophobic, more adherent to silicone catheters, and produced more biofilm than the AB-M strain. Scanning electron microscopy showed bacterial cells with a rough surface and the formation of large cell clusters for AB-NM whereas the AB-M strain had a smooth surface and formed only a few cell clusters. Contrary to the results of most previous studies, cell surface properties were not correlated to the virulence described in our experimental model, indicating that mechanisms other than adherence may be involved in the expression of A.?baumannii virulence.     

Adherence ability and serum resistance of different hospital clusters of Acinetobacter baumannii

The role of mechanical ventilation and catheters in favouring Acinetobacter baumannii infections needs to be better understood. This study evaluated the adherence of 19 isolates of different hospital clusters of A. baumannii to abiotic surfaces and epithelial cells (HEp-2). Of the hydrophobic isolates, 80% adhered to polystyrene, indicating a close relationship between hydrophobicity and adherence. All isolates adhered to epithelial cells to different degrees, and 73·7% showed an aggregated pattern. Analysis of the serum resistance of catheter-tip isolates showed that all were resistant. These worrisome results showed that the high capacity of A. baumannii to adhere to surfaces and survive in human serum could hinder treatment and control of this pathogen.     

Antimicrobial and antifouling efficacy of urinary catheters impregnated with a combination of macrolide and fluoroquinolone antibiotics against Pseudomonas aeruginosa

The incidence of catheter associated urinary tract infections (CAUTIs) is increasing worldwide. This study was designed to modify a biomaterial by impregnating a silicone urinary catheter with combination of a macrolide, azithromycin (AZM) and a fluoroquinolone, ciprofloxacin (CIP). Drug release profiles showed slow yet continuous release of antibiotics from catheters for one month. In vitro efficacy testing showed that group B catheters [3% (w v^?1) CIP + 6% (w v^?1) AZM] outperformed group A catheters [2% (w v^?1) CIP + 5% (w v^?1) AZM] by (1) showing larger zones of inhibition (>31 mm) compared to group A (<28 mm) for up to 30 days against Pseudomonas aeruginosa PAO1; (2) killing adhered bacteria in 24 h compared to 24–48 h in group A; (3) showing longer antimicrobial durability for four weeks; and (4) exhibiting a stable real-time shelf life of one year, suggesting that these catheters can be explored in clinical settings, especially in long-term CAUTI.     

Restoration of tensile strength in bark samples of Ficus benjamina due to coagulation of latex during fast self-healing of fissures

Background and Aims

The functions of plant latex have been discussed for a long time. Today, many studies support a defence mechanism as being its main function. A role as a self-healing mechanism was never attributed to the coagulation of latex. In this study we quantified the contribution of the coagulation of Ficus benjamina (weeping fig) latex to a restoration of the mechanical properties of the bark after external lesions.

Methods

Tensile tests of F. benjamina bark were conducted either immediately after injury or at various latency times after injury.

Key Results

A significant increase in the tensile strength of bark samples until 30 min after injury was found, and this effect could be attributed to the coagulation of plant latex alone. The tensile strength remains nearly constant until several hours or days after injury. Then, very probably due to other mechanisms such as cell growth and cell proliferation, the tensile strength begins to increase slightly again.

Conclusions

The coagulation of latex seals lesions and serves as a quick and effective pre-step of subsequent, more effective, long-lasting self-healing mechanisms such as cell growth and proliferation. Thus, a fast self-healing effect can be included in the list of functions of plant latex.     

Adherence of Pseudomonas aeruginosa to inanimate polymers including biomaterials

Cells of Pseudomonas aeruginosa were adhered to polymethyl methacrylate, polyvinyl acetate, polyvinyl chloride, polyhydroxyethyl methacrylate, mixed-acrylic, silicone, and natural latex materials. Planktonic bacteria and bacteria that adhered to the test materials were compared for their uptake of either L-[3,4,5-³H] leucine or [methyl-³H] thymidine during growth in a minimal medium. Leucine incorporation was reduced and thymidine uptake was negligible in adherent bacteria for up to 8 h following primary attachment by which time cells in the planktonic state showed active uptake of both substrates. These reduced uptake periods correlated with lag phases of growth of adherent cells as determined with a sonication-release plate count procedure and analyses of adenosine triphosphate (ATP). The extent of the lag phase of the adherent populations was dependent on initial densities of adhered cells and the nature of the substratum. Received 02 December 1998/ Accepted in revised form 25 April 1999     

Induced Resistance to Erwinia carotovora ssp. atroseptica, Through the Treatment of Surface Wounds of Potato Tubers with Elicitors

We have investigated the ability of mixed oligogalacturonides, a cell wall hydrolysate from Phytophthora sojae Hildebrand, and chitosan oligomers to induce resistance to Erwinia carotovora ssp. atroseptica in potato tubers (cv. Pentland Squire). Natural infection by Erwinia in stored potatoes generally originates in the surface tissues which have a markedly different biochemical composition to the perimedullary tissue. We therefore investigated the effect of different elicitors in inducing resistance in 2 mm deep wounds made on the surface of potato tubers. When wounded in this way and stored at 20°C and 100% relative humidity, tubers developed a significant level of natural resistance within 24 h. When the potatoes were treated with oligogalacturonides, or Phytophthora cell wall hydrolysate at the time of wounding and challenged with inoculum 8 h later, a significant reduction in disease occurred. Treatment with the chitosan elicitor had no effect on resistance.     

Uropathogenic Escherichia coli adhere to urinary catheters without using fimbriae

Abstract Five well-characterized urinary and fecal isolates of Escherichia coli were found to be hydrophilic irrespective of their serotypes and their ability to express fimbriae. All the strains were able to adhere to silicone latex urinary catheters, although strain 917, which expressed type P fimbriae as its only adhesin, adhered poorly. Although specific adhesins, particularly fimbriae, have been shown to mediate adhesion of E. coli to uroepithelial cells, they do not mediate specific adhesion onto urinary catheter material. The overall surfaces of the strains, tested using microelectrophoresis as a function of pH and X-ray photoelectron spectroscopy, were not significantly different, thus suggesting more non-specific adhesion mechanisms to urinary catheters.     

Anti-biofilm properties of the antimicrobial peptide temporin 1Tb and its ability,in combination with EDTA,to eradicate Staphylococcus epidermidis biofilms on silicone catheters

In search of new antimicrobials with anti-biofilm potential, in the present study activity of the frog-skin derived antimicrobial peptide temporin 1Tb (TB) against Staphylococcus epidermidis biofilms was investigated. A striking ability of TB to kill both forming and mature S. epidermidis biofilms was observed, especially when the peptide was combined with cysteine or EDTA, respectively. Kinetics studies demonstrated that the combination TB/EDTA was active against mature biofilms already after 2–4-h exposure. A double 4-h exposure of biofilms to TB/EDTA further increased the therapeutic potential of the same combination. Of note, TB/EDTA was able to eradicate S. epidermidis biofilms formed in vitro on silicone catheters. At eradicating concentrations, TB/EDTA did not cause hemolysis of human erythrocytes. The results shed light on the anti-biofilm properties of TB and suggest a possible application of the peptide in the lock therapy of catheters infected with S. epidermidis.