INTRODUCTION & OBJECTIVES: Catheter-associated urinary tract infections (CAUTI) are often related with the biofilm development on the catheter surface. Biofilm development in urinary tract catheters is an often underestimated problem. It is, then, important to prevent the biofilm development in order to avoid CAUTI. The aim of the present study was to evaluate the efficacy of solidago, orthosiphon and birch extracts (CISTIMEV®) to decrease microbial colonization and biofilm development in patients with indwelling urinary catheter. MATERIAL & METHODS: 63 patients with indwelling urinary catheter were enrolled in this prospective and controlled study. All patients underwent urine culture and dipstick urinalysis before the urinary substitution and then were divided into two groups: Group A – CISTIMEV® (1 tablet daily for 30 days), Group B – no therapy, control group. After 30 days, the urinary catheter was substituted again and two urine samples were collected (urine culture and dipstick urinalysis). Moreover, a 5cm segment from the tip was separated, fixed in phosphate buffered formalin for scanning electron microscopy (SEM). The segment was cut, longitudinally sectioned for exposing the inner lumen surface, washed twice in distilled water, dehydrated in ascending hydro-alcoholic solutions, vacuum dried and gold sputtered. The two halves were properly mounted on the microscope stub with carbon conductive adhesive to observe both luminal and external surfaces. Biofilm was imaged in a XL30 FEG-FEI microscope at a magnification ranging from 50 to 20000X. Crystal composition was assessed by X-ray energy dispersive spectroscopy. Images and features were interpreted considering also microbial growth. RESULTS: 46 patients were assigned to Group A, while 30 to Group B. At the enrollment time, no differences were reported with regard to clinical, instrumental and laboratory data (Group A: 28/46 showed positive urine culture (60.8%); Group B: 18/30 showed positive urine culture (60%). The most common pathogen was E. coli. CISTIMEV® compounds were well tolerated in all patients analysed and there were no significant drug-related side effects. After 30 days, the two Groups are statistically different in terms of prevalence of positive urine cultures (Group A: 10/46 (21.7%); Group B: 16/30 (53.3%). The most common isolated bacteria were, again, E. coli, E. faecalis and C. albicans (>105 CFU/cm). At the ultrastructural analysis the Group A patients showed a significant lower frequency of bifilm (poly-microbial crystalline biofilm, with three dimensional architectures and extracellular matrix deposition). CONCLUSIONS: This study showed that CISTIMEV® could be able to decrease microbial colonization and biofilm development in patients with indwelling urinary catheter.
Solidago, orthosiphon and birch extracts (CISTIMEV®) are able to decrease microbial colonization and biofilm development in patients with indwelling urinary catheter: Microbiological and ultrastructural study
Tessarolo, Francesco;
2012-01-01
Abstract
INTRODUCTION & OBJECTIVES: Catheter-associated urinary tract infections (CAUTI) are often related with the biofilm development on the catheter surface. Biofilm development in urinary tract catheters is an often underestimated problem. It is, then, important to prevent the biofilm development in order to avoid CAUTI. The aim of the present study was to evaluate the efficacy of solidago, orthosiphon and birch extracts (CISTIMEV®) to decrease microbial colonization and biofilm development in patients with indwelling urinary catheter. MATERIAL & METHODS: 63 patients with indwelling urinary catheter were enrolled in this prospective and controlled study. All patients underwent urine culture and dipstick urinalysis before the urinary substitution and then were divided into two groups: Group A – CISTIMEV® (1 tablet daily for 30 days), Group B – no therapy, control group. After 30 days, the urinary catheter was substituted again and two urine samples were collected (urine culture and dipstick urinalysis). Moreover, a 5cm segment from the tip was separated, fixed in phosphate buffered formalin for scanning electron microscopy (SEM). The segment was cut, longitudinally sectioned for exposing the inner lumen surface, washed twice in distilled water, dehydrated in ascending hydro-alcoholic solutions, vacuum dried and gold sputtered. The two halves were properly mounted on the microscope stub with carbon conductive adhesive to observe both luminal and external surfaces. Biofilm was imaged in a XL30 FEG-FEI microscope at a magnification ranging from 50 to 20000X. Crystal composition was assessed by X-ray energy dispersive spectroscopy. Images and features were interpreted considering also microbial growth. RESULTS: 46 patients were assigned to Group A, while 30 to Group B. At the enrollment time, no differences were reported with regard to clinical, instrumental and laboratory data (Group A: 28/46 showed positive urine culture (60.8%); Group B: 18/30 showed positive urine culture (60%). The most common pathogen was E. coli. CISTIMEV® compounds were well tolerated in all patients analysed and there were no significant drug-related side effects. After 30 days, the two Groups are statistically different in terms of prevalence of positive urine cultures (Group A: 10/46 (21.7%); Group B: 16/30 (53.3%). The most common isolated bacteria were, again, E. coli, E. faecalis and C. albicans (>105 CFU/cm). At the ultrastructural analysis the Group A patients showed a significant lower frequency of bifilm (poly-microbial crystalline biofilm, with three dimensional architectures and extracellular matrix deposition). CONCLUSIONS: This study showed that CISTIMEV® could be able to decrease microbial colonization and biofilm development in patients with indwelling urinary catheter.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
