The Microbiological Burden of Short-Term Catheter Reuse in Individuals with Spinal Cord Injury: A Prospective Study

Tiev Miller; Dirk Lange; Jayachandran N. Kizhakkedathu; Kai Yu; Demian Felix; Soshi Samejima; Claire Shackleton; Raza N. Malik; Rahul Sachdeva; Matthias Walter; Andrei V. Krassioukov

doi:10.3390/biomedicines11071929

The Microbiological Burden of Short-Term Catheter Reuse in Individuals with Spinal Cord Injury: A Prospective Study

Tiev Miller, Dirk Lange, Jayachandran N. Kizhakkedathu, Kai Yu, Demian Felix, Soshi Samejima, Claire Shackleton, Raza N. Malik, Rahul Sachdeva, Matthias Walter, Andrei V. Krassioukov

Rehabilitation Medicine

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Despite the risk of developing catheter-associated urinary tract infections (CAUTI), catheter reuse is common among people with spinal cord injury (SCI). This study examined the microbiological burden and catheter surface changes associated with short-term reuse. Ten individuals with chronic SCI reused their catheters over 3 days. Urine and catheter swab cultures were collected daily for analysis. Scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS) analyses were used to assess catheter surface changes. Catheter swab cultures showed no growth after 48 h (47.8%), skin flora (28.9%), mixed flora (17.8%), or bacterial growth (5.5%). Asymptomatic bacteriuria was found for most participants at baseline (n = 9) and all at follow-up (n = 10). Urine samples contained Escherichia coli (58%), Klebsiella pneumoniae (30%), Enterococcus faecalis (26%), Acinetobacter calcoaceticus–baumannii (10%), Pseudomonas aeruginosa (6%) or Proteus vulgaris (2%). Most urine cultures showed resistance to one or more antibiotics (62%). SEM images demonstrated structural damage, biofilm and/or bacteria on all reused catheter surfaces. XPS analyses also confirmed the deposition of bacterial biofilm on reused catheters. Catheter surface changes and the presence of antibiotic-resistant bacteria were evident following short-term reuse, which may increase susceptibility to CAUTI in individuals with SCI despite asymptomatic bacteriuria.

Original language	English
Article number	1929
Journal	Biomedicines
Volume	11
Issue number	7
DOIs	https://doi.org/10.3390/biomedicines11071929
State	Published - Jul 2023

Bibliographical note

Publisher Copyright:
© 2023 by the authors.

Funding

T.M. is supported by a Michael Smith Foundation for Health Research (MSFHR) postdoctoral fellowship award (#RT-2022-2752) and the Rick Hansen Foundation (RHF) (#2007-21). J.N.K. is a Tier 1 Canada Research Chair and acknowledges the funding from Canadian Institutes of Health Research (CIHR) (#017749). S.S. is supported by a Paralyzed Veterans of America (PVA) postdoctoral fellowship award (#3190), the RHF (#2007-21) and the Wings for Life Spinal Cord Research Foundation (WFLSCRF) (#2020_097). C.S. is supported by a PVA postdoctoral fellowship award (#3189), a CIHR postdoctoral fellowship award (#024871), and the RHF (#2007-21). R.M. is supported by a PVA postdoctoral fellowship award (#3196) and the RHF (#2007-21). R.S. is supported by the WFLSCRF (#WFL-CA-20/21) and the US Department of Defense (#022591 USDEPDEF 2021). M.W. was support by a MSFHR postdoctoral fellowship award (#17110) and the RHF (#2007-21). AVK is the Endowed Chair in the Division of Physical Medicine and Rehabilitation within the Faculty of Medicine at UBC. This investigator-initiated study was supported by a research grant from Coloplast A/S, Humlebaek, Denmark (grant number COLO-AK-NLUTD-SCI: F18-03036). The funder provided a cursory review of the study design and methods involved but had no role in the acquisition and interpretation of data or the decision to publish in this journal.

Funders	Funder number
Coloplast A/S, Humlebaek, Denmark	F18-03036
Division of Physical Medicine and Rehabilitation
U.S. Department of Defense	17110, 022591 USDEPDEF 2021
U.S. Department of Defense
Paralyzed Veterans of America	3190
Paralyzed Veterans of America
Wings for Life Spinal Cord Research Foundation	024871, 2020_097, CA-20/21, 3189, 3196
Wings for Life Spinal Cord Research Foundation
Rick Hansen Foundation	2007-21
Rick Hansen Foundation
Canadian Institutes of Health Research	017749
Canadian Institutes of Health Research
Michael Smith Foundation for Health Research	-2022-2752
Michael Smith Foundation for Health Research
Univ. of Northern British Columbia

Keywords

asymptomatic colonization
bacteria
electron microscopy
intermittent urethral catheterization
lower urinary tract symptoms
neurogenic urinary bladder disorder
photoelectron spectroscopy
spinal cord injury
urinary tract infections

ASJC Scopus subject areas

Medicine (miscellaneous)
General Biochemistry, Genetics and Molecular Biology

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10.3390/biomedicines11071929

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title = "The Microbiological Burden of Short-Term Catheter Reuse in Individuals with Spinal Cord Injury: A Prospective Study",

abstract = "Despite the risk of developing catheter-associated urinary tract infections (CAUTI), catheter reuse is common among people with spinal cord injury (SCI). This study examined the microbiological burden and catheter surface changes associated with short-term reuse. Ten individuals with chronic SCI reused their catheters over 3 days. Urine and catheter swab cultures were collected daily for analysis. Scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS) analyses were used to assess catheter surface changes. Catheter swab cultures showed no growth after 48 h (47.8\%), skin flora (28.9\%), mixed flora (17.8\%), or bacterial growth (5.5\%). Asymptomatic bacteriuria was found for most participants at baseline (n = 9) and all at follow-up (n = 10). Urine samples contained Escherichia coli (58\%), Klebsiella pneumoniae (30\%), Enterococcus faecalis (26\%), Acinetobacter calcoaceticus–baumannii (10\%), Pseudomonas aeruginosa (6\%) or Proteus vulgaris (2\%). Most urine cultures showed resistance to one or more antibiotics (62\%). SEM images demonstrated structural damage, biofilm and/or bacteria on all reused catheter surfaces. XPS analyses also confirmed the deposition of bacterial biofilm on reused catheters. Catheter surface changes and the presence of antibiotic-resistant bacteria were evident following short-term reuse, which may increase susceptibility to CAUTI in individuals with SCI despite asymptomatic bacteriuria.",

keywords = "asymptomatic colonization, bacteria, electron microscopy, intermittent urethral catheterization, lower urinary tract symptoms, neurogenic urinary bladder disorder, photoelectron spectroscopy, spinal cord injury, urinary tract infections",

author = "Tiev Miller and Dirk Lange and Kizhakkedathu, \{Jayachandran N.\} and Kai Yu and Demian Felix and Soshi Samejima and Claire Shackleton and Malik, \{Raza N.\} and Rahul Sachdeva and Matthias Walter and Krassioukov, \{Andrei V.\}",

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AU - Lange, Dirk

AU - Kizhakkedathu, Jayachandran N.

AU - Yu, Kai

AU - Felix, Demian

AU - Samejima, Soshi

AU - Shackleton, Claire

AU - Malik, Raza N.

AU - Sachdeva, Rahul

AU - Walter, Matthias

AU - Krassioukov, Andrei V.

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AB - Despite the risk of developing catheter-associated urinary tract infections (CAUTI), catheter reuse is common among people with spinal cord injury (SCI). This study examined the microbiological burden and catheter surface changes associated with short-term reuse. Ten individuals with chronic SCI reused their catheters over 3 days. Urine and catheter swab cultures were collected daily for analysis. Scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS) analyses were used to assess catheter surface changes. Catheter swab cultures showed no growth after 48 h (47.8%), skin flora (28.9%), mixed flora (17.8%), or bacterial growth (5.5%). Asymptomatic bacteriuria was found for most participants at baseline (n = 9) and all at follow-up (n = 10). Urine samples contained Escherichia coli (58%), Klebsiella pneumoniae (30%), Enterococcus faecalis (26%), Acinetobacter calcoaceticus–baumannii (10%), Pseudomonas aeruginosa (6%) or Proteus vulgaris (2%). Most urine cultures showed resistance to one or more antibiotics (62%). SEM images demonstrated structural damage, biofilm and/or bacteria on all reused catheter surfaces. XPS analyses also confirmed the deposition of bacterial biofilm on reused catheters. Catheter surface changes and the presence of antibiotic-resistant bacteria were evident following short-term reuse, which may increase susceptibility to CAUTI in individuals with SCI despite asymptomatic bacteriuria.

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KW - bacteria

KW - electron microscopy

KW - intermittent urethral catheterization

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KW - photoelectron spectroscopy

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The Microbiological Burden of Short-Term Catheter Reuse in Individuals with Spinal Cord Injury: A Prospective Study

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

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