Preferential Adhesion of Urethral Bacteria from a Mixed Population to a Urinary Catheter

The ability of uropathogens to adhere to catheters and subsequently colonize the urinary mucosa leads to urinary tract infections which afflict a large patient population. In vitro studies were carried out whereby Escherichia coli Hu734 (water contact angle 12 °) and Enterococcus faecalis (19°) were found to be highly adhesive to silicone latex urinary catheters. The addition of one of four Lactobacillus sp., with water contact angles ranging from 19-105 °, to the suspending fluid caused a 60-86% reduction in pathogen adhesion with a significant effect against E. coli, the organism most commonly found to infect the urinary tract. Lactobacilli were significantly effective at displacing uropathogens and preventing their adhesion. Hydrophobic lactobacilli (105 °) were particularly effective at preventing enterococci from adhering from the surface, while more hydrophilic lactobacilli (19-54 °) were most effective at displacing enterococci. The effective competition with four strains of lactobacilli was achieved even when they only comprised 0.1%-7% of the total organisms on the surfaces. These studies demonstrate the important role which the indigenous urethral flora could play in inhibiting the initial attachment of pathogens to catheter surfaces

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Probiotics. Some evidence of their effectiveness

The ability of uropathogens to adhere to catheters and subsequently colonize the urinary mucosa leads to urinary tract infections which afflict a large patient population. In vitro studies were carried out whereby Escherichia coli Hu734 (water contact angle 12°) and Enterococcus faecalis (19°) were found to be highly adhesive to silicone latex urinary catheters. The addition of one of four Lactobacillus sp., with water contact angles ranging from 19-105°, to the suspending fluid caused a 60-86% reduction in pathogen adhesion with a significant effect against E. coli, the organism most commonly found to infect the urinary tract. Lactobacilli were significantly effective at displacing uropathogens and preventing their adhesion. Hydrophobic lactobacilli (105°) were particularly effective at preventing enterococci from adhering from the surface, while more hydrophilic lactobacilli (19-54°) were most effective at displacing enterococci. The effective competition with four strains of lactobacilli was achieved even when they only comprised 0.1% -7% of the total organisms on the surfaces. These studies demonstrate the important role which the indigenous urethral flora could play in inhibiting the initial attachment of pathogens to catheter surfaces

Oral use of probiotics as an adjunctive therapy to fluconazole in the treatment of yeast vaginitis: A study of nigerian women in an outdoor clinic

Ureteral stents are commonly implanted to assist the postsurgery flow of urine from the kidney to the bladder. We hypothesized that different surface compositions of stent material could result in different conditioning film depositions and potentially altered receptivity to bacterial biofilms. Using XPS, three types of ureteral stents recovered from 64 patients were found to have adsorbed conditioning films that altered the surface composition of the devices. Elements associated with encrustation (calcium, magnesium and phosphorus) were found on 69% of the silicone latex stents, 44% of the low surface energy (LSe) devices, and 38% of the carbon-rich stents. No statistical difference was found in relation to patient gender, stent type, duration of implantation, and encrustation deposition. The composition of the film suggested that the nature of the underlying material did not significantly alter the elements that adsorbed. Thus, devices may take on a similar surface coat within days, and perhaps hours, of exposure to the host. With respect to dense encrustations, fewer appeared on the LSe devices. SEM confirmed the presence and nature of the film crystals and showed bacterial biofilms adherent to devices and encrustations in three patients who had received prophylactic trimethoprim compared to one on ciprofioxacin. In conclusion, although encrustation deposition and biofilm formation on ureteral stents is not unique to Cook devices, the human model and surface science test systems described here are invaluable to evaluate biomaterials used in patients. Unless biomaterials undergo rigorous analysis in vivo, including true assessment of the outcome of prophylactic antibiotic usage, clinicians will be unable to accurately select the best device and management strategy for a given patient

Probiotic products in Canada with clinical evidence: What can gastroenterologists recommend?

Summary: Prosthetic devices are commonly used in nephrological and urological practice for the management of urinary and peritoneal dialysis flow, haemodialysis and drainage of renal calculi after laser or lithotripsy treatment. Many different types of materials are used and a number of complications arise, yet the fundamental interactions which occur at these biomaterial surfaces have been little studied. Recent information has shown that host conditioning films are deposited onto materials upon implantation, and that dense bacterial biofllms can form and resist conventional therapy. In order to better manage patients with prostheses, it will be imperative to understand the processes arising in the host and, using scientific data, to select the optimal interventions. Copyright © 1995, Wiley Blackwell. All rights reserve

Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora

Ureteral stents are commonly used in urological practice to drain urine from the kidney, post-operatively. The present study was undertaken to utilize surface science and microbiologicaltechniques for examining three ureteral stent types after indwelling in patients who had been treated with ciprofloxacin. In the nine patients studied, the antibiotic, unlike in a previous study using trimethoprim, prevented bacterial colonization for up to 30 days. Using X-ray photoelectron spectroscopy and scanning electron microscopy/energy dispersive X-ray analysis, it was shown that high levels of encrustations, primarily of calcium carbonate and calcium oxalate, were deposited onto hydrophobic silicone elastomer and Sof-Flex stents. However, a stent with a carbon rich, low surface energy exterior, showed some promise in that there was almost no evidence of encrustation deposition. More extensive trials will confirm whether or not differences between devices are clinically significant. © 1995