Nitric oxide charged catheters as a potential strategy for prevention of hospital acquired infections

<div><p>Background</p><p>Catheter-Associated Hospital-Acquired Infections (HAI's) are caused by biofilm-forming bacteria. Using a novel approach, we generated anti-infective barrier on catheters by charging them with Nitric Oxide (NO), a naturally-produced gas molecule. NO is slowly released from the catheter upon contact with physiological fluids, and prevents bacterial colonization and biofilm formation onto catheter surfaces.</p><p>Aims and methods</p><p>The aim of the study was to assess the anti-infective properties of NO-charged catheters exposed to low concentration (up to 10³ CFU/ml) of microbial cells <i>in-vitro</i>. We assessed NO-charged tracheal tubes using <i>Pseudomonas aeruginosa</i>, dialysis and biliary catheters using <i>Escherichia coli</i>, and urinary catheters using <i>E</i>. <i>coli</i>, <i>Candida albicans</i> or <i>Enterococcus faecalis</i>. Safety and tolerability of NO-charged urinary catheters were evaluated in a phase 1 clinical study in 12 patients. Six patients were catheterized with NO-charged catheters (NO-group), followed by 6 patients catheterized with regular control catheters (CT-group). Comparison of safety parameters between the study groups was performed.</p><p>Results</p><p>NO-charged tracheal, dialysis biliary and urinary catheters prevented <i>P</i>. <i>aerugino</i>sa, <i>E</i>. <i>coli</i> and <i>C</i>. <i>albicans</i> attachment and colonization onto their surfaces and eradicated corresponding planktonic microbial cells in the surrounding media after 24–48 hours, while <i>E</i>. <i>faecalis</i> colonization onto urinary catheters was reduced by 1 log compared to controls. All patients catheterized with an NO-charged urinary catheter successfully completed the study without experiencing NO-related AE's or serious AE's (SAE's).</p><p>Conclusion</p><p>These data highlight the potential of NO-based technology as potential platform for preventing catheter-associated HAI's.</p></div