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. 2022 Apr 1:56:e20210552.
doi: 10.1590/1980-220X-REEUSP-2021-0552. eCollection 2022.

Microbiological and microstructural analysis of indwelling bladder catheters and urinary tract infection prevention

[Article in English, Portuguese]
Mateus Flávio Sousa  1 , Luís Guilherme Oliveira Reis  1 , Valéria da Silva Baracho  2 , Sara Luísa de Oliveira  1 , Gessiane de Fátima Gomes  1 , Thabata Coaglio Lucas  3   4
Affiliations

Microbiological and microstructural analysis of indwelling bladder catheters and urinary tract infection prevention

[Article in English, Portuguese]
Mateus Flávio Sousa et al. Rev Esc Enferm USP. .

Abstract
in English, Portuguese, Spanish

Objective: To analyze the microbiological and microstructural part of indwelling urinary catheters and their association with urinary tract infection prevention.

Method: This is a cross-sectional study, from June to December 2020, in which 42 indwelling urinary catheter tips and sterile urine samples were collected for analysis of crystals in optical microscopy and biofilms in scanning electron microscopy. Culture analysis and specification of the type of bacteria were performed.

Results: It was found that 35.71% of the samples had mature biofilm adhered to the catheter tip. Biofilms of Proteus mirabilis, Enterococcus faecalis, Staphylococcus epidermidis, Enterococcus faecium and Enterobacter cloacae stood out. The presence of magnesium-ammonium-phosphate crystal was associated with the presence of urinary tract infection and with Proteus mirabilis. There was a significant association (p = 0.001) between the use of prophylactic antibiotics versus urine culture >105 CFU/mL.

Conclusion: The analyzes contributed to clinical practice, as it reinforces the development of effective and monitored strategies on cultures and urinary tract infection prevention associated with indwelling urinary catheters.

Objetivo:: Analisar a parte microbiológica e microestrutural dos cateteres vesicais de demora e sua associação com a prevenção de infecção do trato urinário.

Método:: Transversal, entre junho e dezembro de 2020, em que foram coletadas 42 pontas cateteres vesicais de demora e amostras de urina estéril para análise de cristais em microscopia óptica e de biofilmes em microscopia eletrônica de varredura. Fez-se analise de cultura e especificação do tipo de bactérias.

Resultados:: Verificou-se que 35,71% das amostras apresentaram o biofilme maduro aderido à ponta do cateter. Destacaram-se biofilmes de Proteus mirabilis, Enterococcus faecalis, Staphylococcus epidermidis, Enterococcus faecium e Enterobacter cloacae. A presença do cristal magnésio-amônio-fosfato foi associada à presença de infecção do trato urinário e ao Proteus mirabilis. Verificou-se associação significativa (p = 0,001) entre o uso de antibiótico profilático versus a urocultura >105 UFC/mL.

Conclusão:: As análises contribuíram para a prática clínica, pois reforçam a elaboração de estratégias efetivas e monitoradas sobre culturas e prevenção de infecção do trato urinário associada ao cateter vesical de demora.

Objetivo:: Analizar la parte microbiológica y microestructural de los catéteres urinarios permanentes y su asociación con la prevención de la infección del tracto urinario.

Método:: Transversal, de junio a diciembre de 2020, en el que se recolectaron 42 puntas de sonda urinaria permanente y muestras de orina estéril para análisis de cristales en microscopía óptica y biopelículas en microscopía electrónica de barrido. Se realizaron análisis de cultivo y especificación del tipo de bacteria.

Resultados:: Se encontró que el 35,71% de las muestras presentaban biopelícula madura adherida a la punta del catéter. Se destacaron las biopelículas de Proteus mirabilis, Enterococcus faecalis, Staphylococcus epidermidis, Enterococcus faecium y Enterobacter cloacae. La presencia de cristales de fosfato de magnesio-amonio se asoció con la presencia de infección del tracto urinario y con Proteus mirabilis. Hubo una asociación significativa (p = 0,001) entre el uso de antibióticos profilácticos versus urocultivo >105 UFC/mL.

Conclusión:: Los análisis contribuyeron a la práctica clínica, ya que refuerzan el desarrollo de estrategias efectivas y monitoreadas sobre cultivos y prevención de la infección del tracto urinario asociada a los catéteres urinarios permanentes.

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Figures

Chart 1
Chart 1. Comparison of the results of participants’ urine culture and indwelling urinary catheter tip culture – Diamantina, MG, Brazil, 2020 (N = 42).
Chart 2
Chart 2. Detection of crystals identified in optical microscopy (40x) associated with participants – Diamantina, MG, Brazil, 2020 (N = 42).
Figure 1.
Figure 1.. Urinary crystals visualized by optical microscopy. (a) magnesium-ammonium-phosphate crystals; (b) amorphous urate; (c) calcium oxalate (d) uric acid; (e) cylinder and erythrocytes.
Figure 2.
Figure 2.. Mature biofilm adhered to the indwelling bladder catheter wall followed by magnification of the micrograph visualized in scanning electron microscopy.
Figure 3.
Figure 3.. Production of exopolysaccharide matrix, cocci, and protein residues adhered to indwelling catheter visualized in scanning electron microscopy. (a) exopolysaccharide matrix production on the IBD wall and presence of cocci adhered to the biofilm; (b) exopolysaccharide matrix and cocci; (c) protein residue (phase of adhesion to the wall and exopolysaccharide matrix); (d) exopolysaccharide matrix enlargement.
See this image and copyright information in PMC

References

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