You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I (MP46)1 Apr 2020MP46-18 ANTIBIOTIC-RESISTANT UROPATHOGENS FORM BIOFILMS PREDOMINANTLY ON DISTAL AND LUMINAL ASPECTS OF CATHETERS AND ARE INHIBITED BY A NOVEL CETYLPYRIDINIUM CHLORIDE-BASED FORMULATION Glenn Werneburg*, Nadine Henderson, Raymond Rackley, Anh Nguyen, Daniel Shoskes, Amanda Le Sueur, Anthony Corcoran, Aaron Katz, Jason Kim, Annie Rohan, and David Thanassi Glenn Werneburg*Glenn Werneburg* More articles by this author , Nadine HendersonNadine Henderson More articles by this author , Raymond RackleyRaymond Rackley More articles by this author , Anh NguyenAnh Nguyen More articles by this author , Daniel ShoskesDaniel Shoskes More articles by this author , Amanda Le SueurAmanda Le Sueur More articles by this author , Anthony CorcoranAnthony Corcoran More articles by this author , Aaron KatzAaron Katz More articles by this author , Jason KimJason Kim More articles by this author , Annie RohanAnnie Rohan More articles by this author , and David ThanassiDavid Thanassi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000901.018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary catheter biofilms promote bacterial resistance to antibiotics and host cell defenses. Biofilm formation is critical for the pathogenesis of catheter-associated UTI. Here we sought to determine the bacterial composition and antibiotic resistance patterns of bacterial biofilms, as well as their locations on catheters over time. Further, we aimed to test a novel antiseptic formulation, containing cetylpyridinium chloride (CPC) as the active product ingredient combined with pro-adherence factors, for growth inhibition of the biofilm bacterial isolates in liquid medium. METHODS: Urinary catheters were collected following removal from patients, were sectioned and stained for biofilms using crystal violet, and spectrophotometry was used for quantitation. Viability was confirmed via growth in liquid culture, and next generation sequencing via the MicroGenDX platform was employed. Five isolates were cultured, normalized, and subcultured in the presence of the 1:10 or 1:100 antiseptic formulation, or a normal saline control, and growth was measured with spectrophotometry. RESULTS: Thirty-three urinary catheters were included in the study. Biofilm formation increased as a function of time up to 5 weeks. Biofilms predominated on the luminal, balloon, and distal (p=0.034 vs. proximal end) portions of catheters. Uropathogenic bacteria were detected in 10 of 10 samples analyzed using next-generation sequencing (Figure 1a). Genes conferring bacterial resistance to multiple antibiotics were detected in isolates. Relative to the normal saline control, the CPC formulation consistently inhibited growth of the bacterial isolates in a dose-dependent manner (Figure 1b). CONCLUSIONS: Biofilms were composed of uropathogenic bacteria, which were often resistant to common antibiotics. A novel antiseptic formulation inhibited growth of biofilm isolates in a dose-response manner. Biofilm reduction techniques including routine antiseptic irrigation warrant further investigation, as they are well-positioned to target the luminal-predominant biofilms identified in our study and thus may reduce the risk of CAUTI. Source of Funding: NIH T32GM008444 and F30AI112252 (GTW), R01GM062987 (DGT), AACN-Sigma Theta Tau Critical Care Award (AJR) © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e680-e681 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Glenn Werneburg* More articles by this author Nadine Henderson More articles by this author Raymond Rackley More articles by this author Anh Nguyen More articles by this author Daniel Shoskes More articles by this author Amanda Le Sueur More articles by this author Anthony Corcoran More articles by this author Aaron Katz More articles by this author Jason Kim More articles by this author Annie Rohan More articles by this author David Thanassi More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II (MP77)1 Apr 2019MP77-10 PROGRESSION AND FORMATION OF BACTERIAL BIOFILMS ON INDWELLING URINARY CATHETERS OVER TIME Glenn T. Werneburg*, Anh Nguyen, Nadine Henderson, Amanda Le Sueur, Anthony Corcoran, Aaron Katz, Jason Kim, Annie Rohan, and David G. Thanassi Glenn T. Werneburg*Glenn T. Werneburg* More articles by this author , Anh NguyenAnh Nguyen More articles by this author , Nadine HendersonNadine Henderson More articles by this author , Amanda Le SueurAmanda Le Sueur More articles by this author , Anthony CorcoranAnthony Corcoran More articles by this author , Aaron KatzAaron Katz More articles by this author , Jason KimJason Kim More articles by this author , Annie RohanAnnie Rohan More articles by this author , and David G. ThanassiDavid G. Thanassi More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557322.77175.6fAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Urinary catheter biofilm formation is common and consists of adherent bacteria, metabolic products, and host components. Through biofilms, bacteria can resist both antibiotics and host defense mechanisms. Biofilm formation on urinary catheters is a critical step in the pathogenesis of catheter-associated UTI. We sought to determine the catheter locations of onset and progression of biofilm formation. METHODS: Urinary catheters of 0-5 weeks indwelling time were collected. Catheters were then analyzed using spectrophotometry. Specifically, catheters were sectioned and stained with crystal violet, and excess dye was removed. Adherent crystal violet, which represented adherent biofilm, was then dissolved, and the concentration was spectrophotometrically quantitated relative to controls. RESULTS: 33 urinary catheters were collected: 10 in week 1, 6 in week 2, 3 in week 3, 8 in week 4, and 6 in week 5. Biofilms progressed throughout all aspects of the catheter over the 5 weeks indwelling time. The distal end of the catheter exhibited significantly greater staining relative to the proximal side (Figure). The balloon of the catheter consistently showed intense staining, indicative of significant biofilm adherence. CONCLUSIONS: Biofilms progressed as indwelling time increased, and were detected following as little as 1 day indwelling time. The locations of greatest biofilm predominance were the distal portion of the urinary catheter as well as the balloon. We expect that these findings will inform the design and production of novel urinary catheters, which may benefit from focusing antiseptic strategies on the distal and balloon portions of the catheter. Importantly, our findings suggest that biofilms may proliferate through a multimodal etiology, and that sterile insertion technique may prevent early proximal biofilm formation, but may not reduce distal growth. Ongoing studies will determine the bacterial species responsible for biofilm formation, and whether biofilm proliferation is affected by patient sex. Source of Funding: GTW was supported by award T32GM008444 and Award F30AI112252 from the NIH. Shaker Heights, OH; Stony Brook, NY; Mineola, NY; Stony Brook, NY© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1136-e1136 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Glenn T. Werneburg* More articles by this author Anh Nguyen More articles by this author Nadine Henderson More articles by this author Amanda Le Sueur More articles by this author Anthony Corcoran More articles by this author Aaron Katz More articles by this author Jason Kim More articles by this author Annie Rohan More articles by this author David G. Thanassi More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy II1 Apr 2018PD34-03 PRIMARY TREATMENT MODALITY FOR PROSTATE CANCER IS ASSOCIATED WITH RISK OF BIOCHEMICAL RECURRENCE FOLLOWING SALVAGE CRYOTHERAPY Glenn T. Werneburg, Jose M. Salcedo, Amanda L. LeSueur, Jonathan A. Haas, Jeffrey T. Schiff, Anthony T. Corcoran, and Aaron E. Katz Glenn T. WerneburgGlenn T. Werneburg More articles by this author , Jose M. SalcedoJose M. Salcedo More articles by this author , Amanda L. LeSueurAmanda L. LeSueur More articles by this author , Jonathan A. HaasJonathan A. Haas More articles by this author , Jeffrey T. SchiffJeffrey T. Schiff More articles by this author , Anthony T. CorcoranAnthony T. Corcoran More articles by this author , and Aaron E. KatzAaron E. Katz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1570AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Localized prostate cancer is effectively managed with any of several treatment modalities including prostatectomy, radiation (external-beam radiation therapy [EBRT], CyberKnife [CK], brachytherapy), and cryotherapy. Patients with prostate cancer refractory to primary treatment may undergo salvage treatment to control their cancer recurrence. One such salvage treatment is cryotherapy, controlled freezing of the prostate. We sought to determine how the choice of primary treatment affects the risk of biochemical recurrence (BCR) following salvage cryotherapy treatment for refractory prostate cancer. METHODS An IRB-approved database was reviewed for patients who underwent salvage cryotherapy following primary treatment for prostate cancer with EBRT, CK radiation (CK-boost excluded), brachytherapy or cryotherapy. Characteristics of each of these patient cohorts were compared using descriptive statistical analysis. BCR following salvage cryotherapy was determined using the Phoenix criteria and compared using Kaplan Meier and log-rank tests over the 48 months following treatment. RESULTS 211 patients underwent salvage cryotherapy for prostate cancer by a single surgeon from 2004 to 2017: 156 with primary treatment of EBRT, 26 with CK, 17 with primary brachytherapy and 12 with primary cryotherapy. Median age at primary treatment was 64 for EBRT, 63 for CK, 62 for brachytherapy and 69 for cryotherapy (p=0.02). These cohorts did not differ in presalvage PSA (p=0.08) or Gleason scores (p=0.50), time from primary to salvage treatment (p = 0.22), or treatment with androgen deprivation therapy (p=0.15). Patients who underwent primary CK had a higher probability of post-salvage BCR in the 48 months following treatment relative to those who underwent primary brachytherapy (p=0.03) or primary EBRT (p=0.009). There were no differences in post-salvage BCR among primary EBRT, brachytherapy, and cryotherapy groups (p>0.05). CONCLUSIONS Choice of primary treatment may affect disease outcomes following salvage cryotherapy. Patients treated with primary EBRT or primary brachytherapy for prostate cancer were less likely to experience post-salvage BCR relative to patients treated with primary CK. Ongoing studies will investigate the biologic basis for this phenomenon. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e656 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Glenn T. Werneburg More articles by this author Jose M. Salcedo More articles by this author Amanda L. LeSueur More articles by this author Jonathan A. Haas More articles by this author Jeffrey T. Schiff More articles by this author Anthony T. Corcoran More articles by this author Aaron E. Katz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy I1 Apr 2018MP30-09 MODERATE MINIMUM TUMOR TEMPERATURE IN CRYOTHERAPY IS ASSOCIATED WITH SUPERIOR QUALITY OF LIFE AND NO DIFFERENCE IN DISEASE CONTROL IN PROSTATE CANCER PATIENTS Glenn T. Werneburg, Michael Kongnyuy, Daniel M. Halpern, Jose M. Salcedo, Connie Chen, Amanda L. LeSueur, Kaitlin E. Kosinski, Jeffrey T. Schiff, Anthony T. Corcoran, and Aaron E. Katz Glenn T. WerneburgGlenn T. Werneburg More articles by this author , Michael KongnyuyMichael Kongnyuy More articles by this author , Daniel M. HalpernDaniel M. Halpern More articles by this author , Jose M. SalcedoJose M. Salcedo More articles by this author , Connie ChenConnie Chen More articles by this author , Amanda L. LeSueurAmanda L. LeSueur More articles by this author , Kaitlin E. KosinskiKaitlin E. Kosinski More articles by this author , Jeffrey T. SchiffJeffrey T. Schiff More articles by this author , Anthony T. CorcoranAnthony T. Corcoran More articles by this author , and Aaron E. KatzAaron E. Katz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.950AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cryotherapy, the controlled freezing of the prostate gland with a target temperature of -40°C, is an effective definitive treatment for prostate cancer. We sought to determine whether a moderate minimum tumor temperature (below -40°C but above -76°C) is associated with improved quality of life, and/or an increased risk of disease recurrence relative to a very cold temperature (below -76°C). METHODS An IRB-approved database was reviewed for patients who underwent primary cryotherapy for prostate cancer from 2004 to 2017. Cohort characteristics were compared using descriptive statistical analysis. EPIC quality of life questionnaire responses, biochemical recurrence, and progression to salvage treatment over the 4 years post-treatment were analyzed and compared using ANOVA, t-tests, Kaplan Meier analyses, and log-rank tests. Patient cohorts were stratified based on whether their minimum tumor temperatures were colder (″very cold″) or less cold (″moderate-cold″) than -76°C, the median minimum tumor temperature for our cryotherapy patients as determined via chart review. RESULTS Of the 280 patients analyzed, 145 patients had moderate-cold minimum tumor temperatures, and 135 had very cold minimum tumor temperatures during their cryotherapy procedures. EPIC questionnaire data were available for 52 patients in the very cold group and 64 patients in the moderate-cold group in the 4 years following treatment. The groups did not differ in age (p=0.60), preoperative PSA (p=0.07), or preoperative Gleason scores (p=0.30). The groups did not differ in patient-reported urinary function (Panel A, p=0.77) or bowel habits (p=0.15). The moderate cold minimum tumor temperature cohort reported more rapid improvement in sexual function scores relative to the very cold cohort when compared to AS (Panel B, ***p<0.001, indicates comparison to AS at yearly intervals). The groups did not differ in biochemical recurrence (Panel C, p=0.57) or progression to salvage treatment (Panel D, p=0.99). CONCLUSIONS Patients who underwent cryotherapy with a moderate-cold minimum tumor temperature reported a more rapid return of sexual function, but had no difference in biochemical recurrence or progression to salvage treatment relative to the very cold cohort. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e377-e378 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Glenn T. Werneburg More articles by this author Michael Kongnyuy More articles by this author Daniel M. Halpern More articles by this author Jose M. Salcedo More articles by this author Connie Chen More articles by this author Amanda L. LeSueur More articles by this author Kaitlin E. Kosinski More articles by this author Jeffrey T. Schiff More articles by this author Anthony T. Corcoran More articles by this author Aaron E. Katz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy I1 Apr 2018MP30-12 FOCAL CRYOABLATION IS ASSOCIATED WITH SUPERIOR QUALITY OF LIFE AND NO DIFFERENCE IN DISEASE CONTROL RELATIVE TO TOTAL CRYOABLATION IN PROSTATE CANCER PATIENTS Glenn T. Werneburg, Michael Kongnyuy, Daniel M. Halpern, Jose M. Salcedo, Connie Chen, Amanda L. LeSueur, Kaitlin E. Kosinski, Jeffrey T. Schiff, Anthony T. Corcoran, and Aaron E. Katz Glenn T. WerneburgGlenn T. Werneburg More articles by this author , Michael KongnyuyMichael Kongnyuy More articles by this author , Daniel M. HalpernDaniel M. Halpern More articles by this author , Jose M. SalcedoJose M. Salcedo More articles by this author , Connie ChenConnie Chen More articles by this author , Amanda L. LeSueurAmanda L. LeSueur More articles by this author , Kaitlin E. KosinskiKaitlin E. Kosinski More articles by this author , Jeffrey T. SchiffJeffrey T. Schiff More articles by this author , Anthony T. CorcoranAnthony T. Corcoran More articles by this author , and Aaron E. KatzAaron E. Katz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.953AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cryotherapy is an effective definitive treatment for prostate cancer. Cryotherapy may be performed as total ablation of the prostate, or focal ablation with the intention of sparing one or both neurovascular bundles. We sought to determine whether focal ablation of the prostate is associated with improved quality of life (QoL), and/or an increased risk of disease recurrence relative to total cryoablation. METHODS An IRB-approved database was reviewed for patients who underwent primary total or focal cryotherapy for prostate cancer from 2004 to 2017. EPIC quality of life questionnaire responses, biochemical recurrence, and progression to salvage treatment over the 4 years post-treatment were analyzed and compared using ANOVA, t-tests, Kaplan Meier analyses, and log-rank tests. Candidates for focal ablation were chosen based on the combination of criteria including PSA less than 10, unilateral disease, lack of extracapsular extension, interest in maintaining sexual function, and age. RESULTS Of the 300 patients analyzed for disease and QoL outcomes, 104 patients had total cryoablation, and 196 had focal cryoablation (hemiablation). Biochemical recurrence data were available for 232 patients. A total of 335 EPIC QoL questionnaires were included in analysis for 89 patients in the focal group and 38 patients in the total group in the 4 years following treatment. For the focal group, median age was 69 (SD: 8.7), preoperative PSA 6.1 (1.2), available preoperative Gleason scores were <7: 83, 7: 87, 8+: 19. For the total group, median age was 72 (6.9), preoperative PSA 6.1 (5.7), available preoperative Gleason scores were <7: 21, 7: 48, 8+: 32. The cohorts did not differ in 4-year post-procedural urinary function (Panel A, p>0.05) or bowel habits (p>0.05). The focal cryotherapy cohort reported superior sexual function scores relative to the total cryotherapy cohort (Panel B, ***p<0.001). The groups did not differ in biochemical recurrence (Panel C, p=0.55) or progression to salvage treatment (Panel D, p=0.52) in the 4 years post-procedure. CONCLUSIONS Focal cryotherapy results in similar levels of disease control and urinary function, but superior sexual function relative to total cryotherapy in the 4 years following treatment. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e379 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Glenn T. Werneburg More articles by this author Michael Kongnyuy More articles by this author Daniel M. Halpern More articles by this author Jose M. Salcedo More articles by this author Connie Chen More articles by this author Amanda L. LeSueur More articles by this author Kaitlin E. Kosinski More articles by this author Jeffrey T. Schiff More articles by this author Anthony T. Corcoran More articles by this author Aaron E. Katz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...