Pathogenic distribution and drug resistance of bacterial
biofilm on ureteral stent

doi:10.3969/j.issn.2095-4344.2267

Abstract

Abstract:

BACKGROUND: Ureteral stents have been extensively applied in the stenosis in the conjunction of the renal pelvis and ureter, the reconstruction of in situ urine flow, ureter or nephroscope lithotripsy, renal transplant, and tumors. However, the long-term retention of ureteral stents can induce catheter-associated urinary tract infection complications.

OBJECTIVE: To investigate the morphological characteristics of bacterial biofilm on ureteral stent, and to analyze the features of pathogenic distribution and antimicrobial drug resistance to bacterial biofilm.

METHODS: Specimens of ureteral stent were collected from 127 patients at Yongchuan Hospital, Chongqing Medical University between January and December 2016. The morphological characteristics of bacterial biofilm on the stent were observed under scanning electron microscope. Each specimen was divided into three parts (renal pelvis, ureter and bladder) for screening biofilm-forming bacteria strains separately by Congo red medium. The urine was bacterially cultured. Drug susceptibility test was done with the collected biofilm-forming bacteria strains. The study was approved by the Ethics Committee of Yongchuan Hospital, Chongqing Medical University (approval No. 201422).

RESULTS AND CONCLUSION: (1) Bacterial biofilm was observed on the surface of ureteral stents at 7, 15 and 30 days of retention, with various numbers of inflammatory attachments or crystals. Bacteria on the bacterial biofilm were embraced by large amounts of fiber membranes. Patchy bacterial colonies were observed on the surface of the ureteral stent at 7 and 15 days of retention, which mainly focused on bacillus. Heap-shaped bacterial colonies were found on the surface of ureteral stents that were retained for 30 days, which mainly were bacillus and coccus. (2) A total of 106 bacterial biofilms were detected in the ureteral stent samples obtained from 127 patients. The positive rate was 83.5%, in which the bladder section had the highest positive rate, followed by the renal pelvis section and ureter section. There were 25 copies of positive urine culture, and the positive rate was 19.7%. The strains obtained from the bacterial biofilm on each section of the ureteral stents were significantly higher than that from the urine bacteria culture (P < 0.05). (3) A total of 227 strains were detected from 106 positive samples. Among these samples, the number of Gram-negative strains was significantly higher than that of Gram-positive strains (P < 0.05). Among culture bacteria of the bacterial biofilm on the ureteral stent and urine culture bacteria, colibacillus, pseudomonas aeruginosa, enterococcus faecalis and enterococcus faecium were the most common. (4) The biofilm-forming bacteria on the ureteral stent had a high drug resistance. (5) In summary, bacterial biofilm may be the important reason for catheter-associated urinary tract infection.

Key words: bacterial biofilm, ureteral stent, catheter-associated urinary tract infection, drug resistance, nosocomial infections, urine culture, colibacillus, pseudomonas aeruginosa

CLC Number:

Zhang Jiamo, Zhang Xuan, Luo Huaming, Zhao Tao, Chen Jiangchuan, Liu Juan, Wang Ke. Pathogenic distribution and drug resistance of bacterial biofilm on ureteral stent [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(16): 2556-2560.

Figures/Tables 5

References

[1] YAN J, BASSLER BL. Surviving as a Community: Antibiotic Tolerance and Persistence in Bacterial Biofilms.Cell Host Microbe. 2019;26(1):15-21.
[2] TENKE P, KÖVES B, NAGY K, et al. Update on biofilm infections in the urinary tract.World J Urol.2012;30(1):51-57.
[3] GENADY Z, DORON S, GIDEON L, et al. Prevention of Initial Biofilm Formation on Ureteral Stents Using a Sustained Releasing Varnish Containing Chlorhexidine: In Vitro Study.J Endourol. 2013;27(3):333-337.
[4] TEHRANCHI A, REZAEI Y, KHALKHALI H, et al. Effects of terazosin and tolterodine on ureteral stent related symptoms: a double-blind placebo-controlled randomized clinical trial.Int Braz J Urol. 2013;39(6):832-840.
[5] OZGUR BC, EKICI M, YUCETURK CN, et al. Bacterial colonization of double J stents and bacteriuria frequency. Kaohsiung J Med Sci.2013;29(12):658-661.
[6] COSTERTON JW, STEWART PS, GREENBERG EP, et al. Bacterial biofilms: a Common cause of persistent infections. Seience. 1999;284:1318-1322.
[7] DENSTEDT JD, CADIEUX PA. Eliminating bioﬁlm from ureteral stents: the holy grail.Curr Opin Urol. 2009;19:205-210.
[8] MARKUS J, BADER, KATJA Z, et al. Encrustation of urologic double pigtail catheters—an ex vivo optical coherence tomography (OCT) study. Lasers Med Sci. 2013;28:919-924.
[9] GABI M, HEFERMEHL L, LUKIC D, et al. Electrical microcurrent to prevent conditioning film and bacterial adhesion to urological stents.Urol Res.2011;39:81e8.
[10] KLIS R, KORCZAK-KOZAKIEWICZ E, DENYS A, et al. Relationship between urinary tract infection and self-retaining double-J catheter colonization.J Endourol.2009; 23:1015e9.
[11] LOCK JY, WYATT E, UPADHYAYULA S, et al. Degradation and antibacterial properties of magnesium alloys in artificial urine for potential resorbable ureteral stent applications.J Biomed Mater Res A.2014;102:781-792.
[12] AYDIN HR, IRKILATA L, AYDIN M, et al. Incidence of bacterial colonisation after indwelling of double-J ureteral stent.Arch Ital Urol Androl.2016;87:291-294.
[13] LI S, PEPPELENBOSCH MP, SMITS R. Bacterial biofilms as a potential contributor to mucinous colorectal cancer formation. Biochim Biophys Acta Rev Cancer.2019;1872(1):74-79.
[14] OSCAR C, ROBERTO G, CARMELA S, et al. Effect of the combination of clarithromycin and amikacin on Pseudomonas aeruginosa bioﬁlm in an animal model of ureteral stent infection.J Antimicrob Chemother.2011;66:1318-1323.
[15] CAUDA V, FIORI C, CAUDA F, et al. Clinical devicerelated article Ni-Cr-Co alloy ureteral stent:scanning electron microscopy and elemental analysis characterization after long-term indwelling.J Biomed Mater Res B Appl Biomater.2010;94:501-507.
[16] STICKLER DJ, FENELEY RC. The encrustation and blockage of long-term indwelling bladder catheters: a way forward in prevention and control.Spinal Cord.2010;48:784-790.
[17] ZAMANI H, SALEHZADEH A. Biofilm formation in uropathogenic Escherichia coli: association with adhesion factor genes.Turk J Med Sci.2018;48:162-167.
[18] STICKLER DJ. Clinical complications of urinary catheters caused by crystalline biofilms: something needs to be done.J Intern Med. 2014;276:120-129.
[19] 曹晋桂,刘鹏.细菌生物膜､滞留菌及其相关感染防控研究进展[J].中国感染控制杂志,2019,18(5):369-374.
[20] 阿不都赛买提•艾力.非复杂性输尿管镜碎石术后留置输尿管支架管必要性的Meta分析[D].乌鲁木齐:新疆医科大学,2017.
[21] OSCAR C, CARMELA S, ROBERTO G, et al. In vitro and in vivo effects of sub-MICs of pexiganan and imipenem on Pseudomonas aeruginosa adhesion and biofilm development.Infez Med. 2013;4: 287-295.
[22] MARIA MANOHAR C, DOBLE M. Papain immobilized polyurethane as an ureteral stent material. J Biomed Mater Res B Appl Biomater.2016;104(4):723-731.
[23] ZUMSTEIN V, BETSCHART P, ALBRICH WC, et al. Biofilm formation on ureteral stents – Incidence, clinical impact, and prevention.Swiss Med Wkly.2017;147:w1440.
[24] MEIJE Y, ALMIRANTE B, DEL POZO JL, et al. Daptomycin is Effective as Antibiotic-lock Therapy in a Model of Staphylococcus aureus Catheter-related Infection.J Infect.2014;68(6):548-552.
[25] DUPLANTIER AJ, VAN HOEK ML. The Human Cathelicidin Antimicrobial Peptide LL-37 as a Potential Treatment for Polymicrobial Infected Wounds.Front Immunol.2013;3(4):143.