Long-term use of indwelling urinary catheters can lead to urinary tract infections and loss of catheter patency due to encrustation and blockage. Encrustation of urinary catheters is due to formation of crystalline biofilms by urease-producing microorganisms such as Proteus mirabilis. An in vitro catheter biofilm model (CBM) was used to evaluate current methods for maintaining urinary catheter patency. We compared antimicrobial-coated urinary Foley catheters, with both available catheter irrigation solutions and investigational solutions containing NVC-422 (N,N-dichloro-2,2-dimethyltaurine; a novel broad-spectrum antimicrobial). Inoculation of the CBM reactor with 108 colony-forming units of P. mirabilis resulted in crystalline biofilm formation in catheters by 48 h and blockage of catheters within 5 days. Silver hydrogel or nitrofurazone-coated catheters did not extend the duration of catheter patency. Catheters irrigated daily with commercially available solutions such as 0.25 % acetic acid and isotonic saline blocked at the same rate as untreated catheters. Daily irrigations of catheters with 0.2 % NVC-422 in 10 mM acetate-buffered saline pH 4 or Renacidin maintained catheter patency throughout 10-day studies, but P. mirabilis colonization of the CBM remained. In contrast, 0.2 % NVC-422 in citrate buffer (6.6 % citric acid at pH 3.8) resulted in an irrigation solution that not only maintained catheter patency for 10 days but also completely eradicated the P. mirabilis biofilm within one treatment day. These data suggest that an irrigation solution containing the rapidly bactericidal antimicrobial NVC-422 in combination with citric acid to permeabilize crystalline biofilm may significantly enhance catheter patency versus other approved irrigation solutions and antimicrobial-coated catheters.

INTRODUCTION:Necrotizing fasciitis (NF) is a rare and rapidly progressing bacterial infection of soft tissues. Bacterial toxins cause local tissue damage and necrosis, as well as blunt immune system responses. A self-propagating cycle of bacterial invasion, toxin release and tissue destruction can continue until substantial amounts of tissue become necrotic. Neutralization of bacterial toxins should improve the results.MATERIALS AND METHODS:Pure hypochlorous acid (HOCl) (0.01% w/v) with no sodium hypochlorite impurity in saline pH 4-5, which was recently shown to both eradicate bacteria and neutralize bacterial toxins in vitro, was administered via flowthrough instillation to 6 patients with NF 4-6 times daily as needed. Utilizing a vacuum-assisted closure, 5-10 mL of pure 0.01% HOCl with no sodium hypochlorite impurity was instilled and removed frequently to irrigate the wounds.RESULTS:Of the 6 patients, no deaths or limb amputations occurred. All infected areas healed completely without major complications.CONCLUSION:The toxicity and immune dysfunction caused by bacterial toxins and toxins released from damaged cells may be mitigated by flow-through instillation with saline containing pure 0.01% HOCl with no sodium hypochlorite impurity. Randomized controlled clinical trial research of this relatively simple and inexpensive instillation protocol is suggested for identified cases of NF.

You have accessJournal of UrologyStone Disease: Basic Research I1 Apr 2014MP20-01 AURICLOSENE IRRIGATION SOLUTION PREVENTS ENCRUSTATION BY CRYSTALLINE BIOFILM DUE TO PROTEUS MIRABILIS IN AN IN VITRO URINARY CATHETER PATENCY MODEL Suriani Abdul Rani, Ramin (Ron) Najafi, Keith Bley, William Costerton, David Stickler, Bernard Churchill, and Dmitri Debabov Suriani Abdul RaniSuriani Abdul Rani More articles by this author , Ramin (Ron) NajafiRamin (Ron) Najafi More articles by this author , Keith BleyKeith Bley More articles by this author , William CostertonWilliam Costerton More articles by this author , David SticklerDavid Stickler More articles by this author , Bernard ChurchillBernard Churchill More articles by this author , and Dmitri DebabovDmitri Debabov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.723AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Long-term indwelling urinary catheters are susceptible to blockage due to formation of crystalline biofilms by urease-producing microorganisms such as Proteus mirabilis. An in vitro catheter biofilm model (CBM) was developed to compare current methods for maintaining urinary catheter patency. We compared various bladder irrigation solutions or antimicrobial-coated urinary catheters, versus a novel antimicrobial catheter irrigation solution containing auriclosene (N,N-dichloro-2,2-dimethyltaurine; formerly designated NVC-422). METHODS CBM units were fed artificial urine at 0.5 mL per min. The artificial bladder chamber was inoculated with 108 colony forming units (CFU) of P. mirabilis and biofilm was allowed to establish for 48 hours before daily treatments commenced. A single treatment consisted of two sequential 50 mL irrigations. Each irrigation was retained in the catheter for 15 min and then drained, with a 30 min washout period between the two irrigations. Experiments were conducted for up to 10 days or until catheter blockage. The pH of the effluent, CFU counts in the bladder chamber and the time to catheter blockage were recorded. The area of catheter encrustation was measured using Stereo Zoom imaging. RESULTS Inoculation of the CBM reactor with 108 CFU of P. mirabilis resulted in blockage of the urinary catheters within 5 days. The use of silver-hydrogel or nitrofurazone-coated catheters did not extend the period of catheter patency. Catheter irrigation with 0.25% acetic acid or isotonic saline blocked at the same rate as untreated catheters. Catheters irrigated with a citrate-buffered formulation of 0.2% auriclosene resulted in maintenance of catheter patency for 10 days and complete eradication of P. mirabilis and biofilm within one treatment day. In contrast, daily irrigations of infected catheters with 10 mM acetate-buffered saline (at pH 4) or Renacidin® Irrigation Solution had no effect on P. mirabilis colonization of the bladder chamber, even though catheter patency was maintained throughout 10-day studies. CONCLUSIONS Irrigation with the rapidly bactericidal antimicrobial auriclosene in a buffered acidic formulation - termed Auriclosene Irrigation Solution - significantly enhanced catheter patency in vitro versus other irrigation solutions and antimicrobial-coated urinary catheters. Clinical evaluation of Auriclosene Irrigation Solution is ongoing. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e196 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Suriani Abdul Rani More articles by this author Ramin (Ron) Najafi More articles by this author Keith Bley More articles by this author William Costerton More articles by this author David Stickler More articles by this author Bernard Churchill More articles by this author Dmitri Debabov More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...