1887

Abstract

The crystalline biofilms formed by can seriously complicate the care of patients undergoing long-term bladder catheterization. The generation of alkaline urine by the bacterial urease causes calcium and magnesium phosphates to precipitate from urine and accumulate in the catheter biofilm, blocking the flow of urine from the bladder. The pH at which these salts crystallize from a urine sample, the nucleation pH (pH), can be elevated by diluting the urine and by increasing its citrate content. The aim of this study was to examine whether manipulation of pH in these ways modulated the rate at which crystalline biofilm developed. Experiments in laboratory models of the catheterized bladder infected with showed that when the bladder was supplied with a concentrated urine (pH 6·7) at a low fluid output (720 ml per 24 h), catheters blocked at 19–31 h. Diluting this urine 1 : 4 increased the pH to 7·5 and models supplied with this urine at 2880 ml per 24 h took 110–137 h to block. When models were supplied with urine containing citrate at 1·5 mg ml or above (pH 8·3–9·1), the catheters drained freely for the full 7 day experimental period. Scanning electron microscopy revealed that the catheter biofilms that developed in urine with high pH values were devoid of crystalline formations. These observations should encourage a clinical trial to examine the effect of increasing a patient's fluid intake with citrate-containing drinks on the encrustation and blockage of catheters.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.46404-0
2006-05-01
2019-11-17
Loading full text...

Full text loading...

/deliver/fulltext/jmm/55/5/489.html?itemId=/content/journal/jmm/10.1099/jmm.0.46404-0&mimeType=html&fmt=ahah

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. Br J Urol 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. 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]
  5. Hedelin, H., Bratt, C. G., Eckerdal, G. & Lincoln, K. ( 1991; ). Relationship between urease-producing bacteria, urinary pH and encrustation on indwelling urinary catheters. Br J Urol 67, 527–531.[CrossRef]
    [Google Scholar]
  6. Kunin, C. M. ( 1997; ). Care of the urinary catheter. In Urinary Tract Infections: Detection, Prevention and Management, 5th edn, pp. 226–278. Baltimore: Williams & Wilkins.
  7. Mathur, S., Suller, M. T. E., Stickler, D. J. & Feneley, R. C. L. ( 2006; ). Prospective study of individuals with long-term urinary catheters colonized with Proteus species. Br J Urol Int 97, 121–128.[CrossRef]
    [Google Scholar]
  8. Morris, N. S. & Stickler, D. J. ( 2001; ). Does drinking cranberry juice produce urine inhibitory to the development of crystalline, catheter-blocking Proteus mirabilis biofilms? Br J Urol Int 88, 192–197.[CrossRef]
    [Google Scholar]
  9. 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]
  10. 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]
  11. 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]
  12. 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]
  13. 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]
  14. 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]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.46404-0
Loading
/content/journal/jmm/10.1099/jmm.0.46404-0
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error