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  • Print publication year: 2003
  • Online publication date: November 2009

7 - Biofilm Complications of Urinary Tract Devices



The anatomy of the urinary tract, unfortunately, allows ready access by pathogens to the urethra and beyond when normal defences are breached. The potential for urinary tract infection (UTI) is considerably enhanced by the presence of an indwelling device such as a urethral catheter that provides a conduit to the bladder (Tunney, Jones, and Gorman, 1999). This allows not only the voiding of urine, but also the ingress of microorganisms that colonise the device material and adopt a biofilm growth mode. Such ‘device-related’ infection is a frequent occurrence in the urinary tract, requiring considerable time and resource in its management. It is estimated that over 40 per cent of nosocomial infections are related to the urinary tract (Nickel, Downey, and Costerton, 1989). Despite careful aseptic management, bacteriuria arises in approximately 50 per cent of patients within 10–14 days and in all those undergoing long-term catheterisation for management of urinary retention and incontinence by 28 days. Additional complications such as blocking encrustations, stone formation, pyelonephritis, and bladder cancer may also arise in patients with asymptomatic infection (Gorman and Tunney, 1997). The elderly are particularly prone to urinary device-related infection. Residents of nursing homes undergoing long-term catheterisation are three times more likely to receive antibiotics, be hospitalised, and die within a year than matched non-catheterised residents (Kunin, Chin, and Chambers, 1987).

The obstruction of urine flow in urinary devices by crystalline encrustation is an additional clinical complication.

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Adair, C. G., Gorman, S. P., O'Neill, F., McClurg, B., Goldsmith, E. C. and Webb, C. H., (1993). Selective decontamination of the digestive tract (SDD) does not attain sufficient antibiotic concentration in tracheal secretions to prevent the formation of microbial biofilm on endotracheal tubes. Journal of Antimicrobial Chemotherapy, 31, 689–697
Adair, C. G., Gorman, S. P., Byers, L. M., Gardner, T. and Jones, D. S. (2000). Confocal laser scanning microscope examination of microbial biofilms. In Handbook of Bacterial Adhesion, eds. Y. H. An and R. J. Friedman, pp. 249–259. New Jersey: Humana Press
Adams, J. (1994). Renal stents. Emergency Medical Clinics of North America, 12, 749–758
Bach, A., Darby, D., Bottiger, B., Bohrer, H., Motsch, J. and Martin, E. (1996). Retention of the antibiotic teicoplanin on a hydromer-coated central venous catheter to prevent bacterial colonisation in postoperative surgical patients. Intensive Care Medicine, 22, 1066–1069
Baldassarri, L., Gelosia, A., Fiscarelli, E., Donnelli, G., Mignozzi, M. and Rizzoni, G. (1994). Microbial colonisation of implanted silicone and polyurethane catheters. Journal of Materials Science. Materials in Medicine, 5, 601–605
Bambauer, R., Mestres, P., Schiel, R. and Sioshansi, P. (1995). New surface-treatment technologies for catheters used for extracorporeal detoxification methods. Dialysis and Transplantation, 24, 228
Bambauer, R., Mestres, P., Schiel, R., Klinkmann, J. and Sioshansi, P. (1997). Surface-treated catheters with ion-beam process evaluation in ratsArtificial Organs, 21, 1039–1041
Beckett, G., Schep, L. J., Crichton, D. and Jones, D. S. (1997). Chlorhexidine sorption into and release from dental prosthetic biomaterials. Journal of Pharmacy and Pharmacology, 49(S4), 135
Bilbruck, J., Hanlon, G. W. and Martin, G. P. (1993). The effect of polyHEMA coating on the adhesion of bacteria to polymer monofilaments. International Journal of Pharmaceutics, 99, 293–301
Bonner, M., Keane, P. F. and Gorman, S. P. (1993). Characterisation and antibiotic sensitivities of isolates from ureteral stent biofilm. Journal of Pharmacy and Pharmacology, 45, 1445
Bonner, M. C., Tunney, M. M., Jones, D. S. and Gorman, S. P. (1997). Factors affecting in vitro adherence of ureteral stent biofilm isolates to polyurethane. International Journal of Pharmaceutics, 151, 201–207
Bridgett, M. J., Davies, M. C. and Denyer, S. P. (1992). Control of Staphlococcal adhesion to polystyrene surfaces by polymer surface modification with surfactants. Biomaterials, 13, 411–416
Brown, A. F., Jones, D. S. and Woolfson, A. D. (1998). Effect of hexetidine and triclosan on the curing and mechanical properties of silicone elastomer. Journal of Pharmacy and Pharmacology, 50, 105
Bryers, J. D. and Hendricks, S. (1997). Bacterial infection of biomaterials – experimental protocol for in vitro adhesion studies. Annals of the New York Academy of Sciences, 831, 127–137
Choong, S., Wood, S., Fry, C. and Whitfield, H. (2001). Catheter-associated urinary tract infection and encrustation. International Journal of Antimicrobial Agents, 17, 305–310
Chronos, N. A. F., Robinson, K. A., Kelly, A. B., Taylor, A., Yianni, J., King, S. B., Harker, L. A. and Hanson, R. (1995). Thromboresistant phosphorylcholine coating for coronary stents. Circulation, 92, I–685
Clapham, L, Article, R. J. C.Nickel, J. C. and Downey, J. (1990). The influence of bacteria on struvite crystal habit and its importance in urinary stone formation. Journal of Crystal Growth, 104, 475–484
Cormio, L., Vuopio-Varkila, J., Siitonen, A., Talja, M. and Ruutu, M. (1995). Biocompatibility of various indwelling double J stents in vivo and in vivo. Scandinavian Journal of Urology and Nephrology, 30, 19–24
Cormio, L., Forgia, P., Forgia, D., Siitonen, A. and Ruutu, M. (1997). Is it possible to prevent bacterial adhesion onto ureteric stents? Urological Research, 25, 213–216
Costerton, J. W., Khoury, A. E., Ward, K. H. and Anwar, H. (1993). Practical measures to control device-related bacterial infections. International Journal of Artificial Organs, 16, 765–770
Costerton, J. W. (1999). Introduction to biofilm. International Journal of Antimicrobial Agents, 11, 217–221
Cox, A. J. and Hukins, D. W. L. (1989). Morphology of mineral deposits on encrusted urinary catheters investigating by scanning electron microscopy. Journal of Urology, 142, 1347–1350
Cox, A. J., Hukins, D. W. L. and Sutton, T. M. (1989). Infection of catheterised patients: bacterial colonisation of encrusted foley catheters shown by scanning electron microscopy. Urological Research, 17, 349–352
Darouiche, R. O., Hampel, O. Z., Boone, T. B. and Raad, I. I. (1997). Antimicrobial activity and durability of a novel antimicrobial-impregnated bladder catheter. International Journal of Antimicrobial Agents, 8, 243–247
Darouiche, R. O., Raad, I. M., Heard, S. O., Thornby, J. I., Wenker, O. C., Gabrielli, A., Berg, J., Khardori, N., Hanna, H., Hachem, R., Harris, R. L. and Mayhall, G. (1999). A comparison of two antimicrobial-impregnated central venous catheters. New England Journal of Medicine, 340, 1–8
Denyer, S. P., Hanlon, G. W., Davies, M. C. and Gorman, S. P. (1993). Antimicrobial and other methods for controlling microbial adhesion in infection. In Microbial Biofilms: Formation and Control, eds. S. P. Denyer, S. P. Gorman and M. Sussman, pp. 147–165. Oxford: Blackwell Scientific Publications
Desai, N. P., Hossainy, S. F. and Hubbell, J. A. (1992). Surface-immobilised polyethylene oxide for bacterial repellence. Biomaterials, 13, 417–420
Djokic, J., Jones, D. S. and Gorman, S. P. (1998). Development of a novel polymer coating for urinary medical devices: assessment of biodegradation and resistance to encrustation. Journal of Pharmacy and Pharmacology, 50, 172
Djokic, J., Jones, D. S., Gorman, S. P. and McGrath, S. (1999). Assessment of resistance of poly(-caprolactone) films, impregnated with povidone-iodone, to Escherichia coli adherence. Journal of Pharmacy and Pharmacology, 51, 33
Dumanski, A. J., Hedelin, H., Edin-Liljegren, A., Beauchemin, D. and McLean, R. (1994). Unique ability of the Proteus mirabilis capsule to enhance mineral growth in infectous urinary calculi. Infection and Immunity, 62, 2998–3003
Dunkirk, S. G., Gregg, S. L., Duran, L. W., Monsfiels, J. D., Haapala, J. E.. (1991). Photochemical coatings for the prevention of bacterial colonisation. Journal of Biomaterials Applications, 6, 131–155
Elves, A. W. S. and Feneley, R. C. L. (1997). Long-term uretheral catheterisation and urine biomaterial interferance. British Journal of Urology, 80, 1–5
Fallgren, C., Utt, M., Petersson, A. C., Ljungh, A. and Wadstrom, T. (1998). In vitro anti-staphylococcal activity of heparinized biomaterials bonded with combinations of rifampicin. Zentralblatt fur Bakteriologie, 287, 19–31
Farber, B. F. and Wolff, A. G. (1993). Salicylic acid prevents the adherence of bacteria and yeast to silastic catheters. Journal of Biomedical Materials Research, 27, 599–602
Fuqua, C. and Greenberg, E. P. (1998). Self-perception in bacteria: quorum sensing with acylated homoserine lactones. Current Opinion in Microbiology, 1, 183–189
Gabriel, M. M., Mayo, M. S., May, L. L., Simmons, R. B. and Ahearn, D. G. (1996). In vitro evaluation of the efficacy of a silver-coated catheter. Current Microbiology, 33, 1–5
Gilbert, P., Evans, D. J. and Brown, M. R. W. (1993). Formation and dispersal of bacterial biofilms in vivo and in situ. Journal of Applied Bacteriology, 74, S67–S78
GoeauBrissonniere, O., Lef lon, V., Letort, M. and Nicolas, M. H. (1999). Resistance of antibiotic bonded gelatin coated polymer meshes to Staphylococcus aureus in a rabbit subcutaneous pouch model. Biomaterials, 20, 229–232
Golomb, G. and Shpigelman, A. (1991). Prevention of bacterial colonisation on polyurethane in vitro by incorporated antibacterial agent. Journal of Biomedical Material Research, 25, 937–952
Gorman, S. P. (1991). Microbial adherence and biofilm production. In Mechanisms of Action of Chemical Biocides, eds. S. P. Denyer and W. B. Hugo, pp. 271–295. Oxford: Blackwell Scientific Publications
Gorman, S. P., McCafferty, D. F., Woolfson, A. D. and Jones, D. S. (1987). A comparative study of the microbial anti-adherence capacities of three antimicrobial agents. Journal of Clinical Pharmacy and Therapeutics, 12, 393–399
Gorman, S. P., Woolfson, A. D. and McCafferty, D. F. (1991a). Elemental analysis of latex and polymer-coated urinary catheter encrustation by a novel electron probe and digimap technique. Proceedings of the 10th Pharmaceutical Technology Conference, Bologna, Italy, 2, 649–651
Gorman, S. P., Woolfson, A. D. and McCafferty, D. F. (1991b). Microbial adherence andbiofilm formation on latex and polymer-coated urinary catheters: role of hydrophobicity. Proceedings of 10th Pharmaceutical Technology Conference, Bologna, Italy, 2, 661–663
Gorman, S. P., Adair, C. G., O'Neill, F., Goldsmith, E. C. and Webb, C. H. (1993a). Influence of selective decontamination of the digestive tract on microbial biofilm formation on endotracheal tubes from artificially ventilated patients. European Journal of Clinical Microbiology and Infectious Diseases, 12, 9–17
Gorman, S. P., Mawhinney, W. M., Adair, C. G. and Issouckis, M. (1993b). Confocal scanning laser microscopy of CAPD catheter surface microrugosity in relation to recurrent peritonitis. Journal of Medical Microbiology, 38, 411–417
Gorman, S. P., Mawhinney, W. M. and Adair, C. G. (1993c). The influence of a protein-conditioning film and cell surface hydrophobicity on bacterial adherence to silicone and polyurethane CAPD catheters. Proceedings of the 12th Pharmaceutical Technology Conference, Copenhagen, Denmark, 2, 465–468
Gorman, S. P., Adair, C. G. and Mawhinney, W. M. (1994). Incidence, nature and antibiotic resistance of CAPD catheter biofilm in relation to peritonitis. Epidemiology and Infection, 112, 551–559
Gorman, S. P. and Tunney, M. M. (1997). Assessment of encrustation behaviour on urinary tract biomaterials. Journal of Biomedical Material Research, 12, 136–166
Gorman, S. P., Tunney, M. M., Keane, P. F., van Bladel, K. and Bley, B. (1998). Characterisation and assessment of a novel poly(ethylene oxide)/polyurethane composite hydrogel (Aquavene) as a ureteral stent biomaterial. Journal of Biomedical Material Research, 39, 642–650
Gorman, S. P., McGovern, J. G., Woolfson, A. D., Adair, C. G. and Jones, D. S. (2001). The concomitant development of poly(vinylchloride)-related biofilm and antimicrobial resistance in relation to ventilator-associated pneumonia. Biomaterials, 22, 2741–2747
Greenfeld, J. I., Sampath, L., Popilskis, S. J. and Brunnert, S. R. (1995). Decreased bacterial adherence and biofilm formation on chlorhexidine and silver sulfadiazine-impregnated central venous catheters implanted in swine. Critical Care Medicine, 23, 894–900
Griffith, D. P., Musher, D. M. and Itin, C. (1976). Urease-the primary cause of infection-induced urinary stones. Investigative Urology, 13, 346–350
Griffith, D. P. (1978). Struvite stones. Kidney International, 13, 372–382
Gristina, A. G. (1987). Biomaterial-centered infection: microbial adhesion versus tissue integration. Science, 237, 1588–1595
Hardhammer, P. A., Beusekom, H. M. M., Emanuelsson, H. U., Hofma, S. H., Albertsson, P. A., Verdouw, P. D., Boersma, E., Serruys, P. W. and Giessen, W. J. (1996). Reduction in thrombotic events with heparin-coated Palmaz–Schatz stents in normal porcine coronary arteries. Circulation, 93, 423–430
Harvey, R. A., Tesoriero, J. V. and Greco, R. S. (1984). Non-covalent bonding of penicillin and cefazolin to Dacron. American Journal of Surgery, 147, 205–209
Heard, S. O., Wagle, W., Vijayakumar, E., McLean, S., Brueggemann, A., Napolitanho, L. M., Edwards, P., O'Connell, F. M., Puyana, J. C. and Doern, G. V. (1998). Influence of triple-lumen central venous catheters coated with chlorhexidine and silver sulfadiazine on the incidence of catheter-related bacteremia. Archives of Internal Medicine, 158, 81–87
Hustinx, W. N. M. and Verbrugh, H. A. (1994). Catheter associated urinary tract infections: epidemiological, preventive and therapeuric considerations. International Journal of Antimicroial Agents, 4, 117–123
Ishihara, K., Aragaki, R., Ueda, T., Watenabe, A. and Nakabayashi, N. (1990). Reduced thrombogenicity of polymers having phospholipids polar group. Journal of Biomedical Materials Research, 24, 1069–1077
Jansen, B., Schumacher-Perdreau, F., Peters, G. and Pulverer, G. (1989). New aspects in the pathogenesis and prevention of polymer associated foreign body infections caused by coagulase-negative staphylococci. Journal of Investigative Surgery, 2, 361–380
Jansen, B. and Peters, G. (1991). Modern strategies in the prevention of polymer-associated infections. Journal of Hospital Infection, 19, 83–88
Jansen, B., Jansen, S., Peters, G. and Pulverer, G. (1992a). In vitro efficacy of a central venous catheter (Hydrocath) loaded with teicoplanin to prevent bacterial colonization. Journal of Hospital Infection, 22, 93–107
Jansen, B., Kristinsson, K. G., Jansen, J., Peters, G. and Pulverer, G. (1992b). In vitro efficacy of a central venous catheter complexed with iodine to prevent bacterial colonisation. Journal of Antimicrobial Chemotherapy, 30, 135–139
Jansen, B., Goodman, L. P. and Ruiten, D. (1993). Bacterial adherence to hydrophilic polymer-coated polyurethane stents. Gastrointestinal Endoscopy, 39, 670–673
John, S. F., Hillier, V. F., Handley, P. S. and Derrick, M. R. (1995). Adhesion of Staphylococci to polyurethane and hydrogel-coated polyurethane catheters assayed by an improved radiolabelling technique. Journal of Medical Microbiology, 43, 133–140
Johnson, J. R., Delavari, P. and Azar, M. (1999). Activities of a nitrofurazone-containing urinary catheters and a silver hydrogel catheter against multidrug resistant bacteria characteristic of catheter-associated urinary tract infection. Antimicrobial Agents and Chemotherapy, 43, 2990–2995
Jones, C. R., Handley, P. S., Robson, G. D., Eastwood, I. M. and Greenhalgh, M. (1996). Biocides incorporated into plasticised polyvinyl chloride reduce adhesion of Pseudomonas fluorescens B1146 and substratum hydrophobicity. Journal of Applied Bacteriology, 81, 553–560
Jones, D. S., Gorman, S. P., McCafferty, D. F. and Woolfson, A. D. (1991). The effects of three non-antibiotic antimicrobial agents on the surface hydrophobicity of certain micro-organisms evaluated by different methods. Journal of Applied Bacteriology, 71, 218–227
Jones, D. S., Garvin, C. P. and Gorman, S. P., (2001a). Design of a simulated urethra model for the quantitative assessment of urinary catheter lubricity. Journal of Matererials Science. Materials in Medicine, 12, 15–21
Jones, D. S., McGovern, J. G., Adair, C. G., Woolfson, A. D. and Gorman, S. P. (2001b). Conditioning film and environmental effects on the adherence of Candida spp. to silicone and poly(vinylchloride) biomaterials. Journal of Materials Science. Materials in Medicine, 12, 399–405
Jones, D. S., McGovern, J. G., Woolfson, A. D., Adair, C. G. and Gorman, S. P. (2002). Physicochemical characterisation of hexetidine impregnated endotracheal tube poly(vinylchloride) and resistance to adherence of respiratory bacterial pathogens. Pharmaceutical Research, 19, 818–824
Keane, P. F., Bonner, M., Johnston, S. R., Zafar, A. and Gorman, S. P. (1994). Characterisation of biofilm and encrustation on ureteric stents in vivo. British Journal of Urology, 73, 687–691
Kohnen, W. and Jansen, B. (1995). Polymer material for the prevention of catheter-related infections. Zentralblatt fur Bakteriologie, 283, 175–186
Kohnen, W., Schaper, J., Klien, O., Tieke, B. and Jansen, B. (1998). A silicone ventricular catheter coated with a combination of rifampin and trimethoprim for the prevention of catheter-related infections. Zentralblatt fur Bakteriologie, 287, 147–156
Kristinsson, K. G., Jansen, B., Treitz, U., Schumacher-Perdreau, F., Peters, G. and Pulverer, G., (1991). Antimicrobial activity of polymers coated with iodine-complexed polyvinylpyrrolidone. Journal of Biomaterials Applications, 5, 173–184
Kunin, C. M., Chin, Q. F. and Chambers, S. (1987). Morbidity and mortality associated with indwelling urinary catheters in elderly patients in a nursing home – confounding due to the presence of associated diseases. Journal of the American Geriatric Society, 35, 1001–1006
Lachapelle, K., Graham, A. M. and Symes, J. F. (1994). Antibacterial activity, antibiotic retention and infection resistance of a rifampin-impregnated gelatin sealed Dacron graft. Journal of Vascular Surgery, 19, 675–682
Liedberg, H., and Lundeberg, T. (1989). Silver coating of urinary catheters prevents adherence and growth of Pseudomonas aeruginosa. Urolological Research, 17, 357–358
Liedl, B. and Hofstetter, A. (2000). Pathogenese und verhinderung katheterassoziierter harnwegsinfektionen. Urologie B, 40, 233–237
Liedl, B. (2001). Catheter-associated urinary tract infections. Current Opinion in Urology, 11, 75–79
McAllister, E. W., Carey, L. C., Brady, P. G. and Heller, R. (1993). The role of polymeric surface smoothness of biliary stents in bacterial adherence, biofilm deposition, and stent occlusion. Gastrointestinal Endoscopy, 39, 422–425
McLean, R. J. C., Downey, J., Clapham, L. and Nickel, J. C. (1990). A simple technique for studying struvite crystal growth in vitro. Urological Research, 18, 39–43
McLean, R. J. C., Lawrence, J. R., Korber, D. R. and Caldwell, D. E. (1991a). Proteus mirabilis biofilm protection against struvite crystal dissolution and its implications in struvite urolithiasis. Journal of Urology, 146, 1138–1142
McLean, R. J. C., Downey, J., Clapham, L., Wilson, J. W. L. and Nickel, J. C. (1991b). Pyrophosphate inhibition of Proteus mirabilis induced struvite crystallization in vitro. Clinica Chimica Acta, 200, 107–118
McGovern, J. G., Garvin, C. P., Jones, D. S., Woolfson, A. D. and Gorman, S. P. (1997). Modification of biomaterial surface characteristics by body fluids in vitro. International Journal of Pharmaceutics, 149, 251–254
Maki, D. G., Stolz, S. M., Wheeler, S. and Mermel, L. A. (1997). Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. Annals of Internal Medicine, 127, 257–266
Mobley, H. L. T. and Warren, J. W. (1987). Urease-positive bacteriuria and obstruction of long-term urinary catheter. Journal of Clinical Microbiology, 25, 2216–2217
Monson, T. and Kunin, C. M. (1974). Evaluation of a polymer-coated indwelling catheter in prevention of infection. Journal of Urology, 111, 220–222
Morris, N. S. and Stickler, D. J. (1998). Encrustation of indwelling uretheral catheters by Proteus mirabilis biofilms growing in human urine. Journal of Hospital Infection, 39, 227–234
Morris, N. S., Stickler, D. J. and McClean, R. J. C. (1999). The development of bacterial biofilms on indwelling urethral catheters. World Journal of Urology, 17, 245–350
Multanen, M., Talja, M., Hallanvuo, S., Siitonen, A., Välimaa, T., Tammela, T. L. J., Seppälä, J. and Törmälä, P. (2000). Bacterial adherence to ofloxacin-blended polylactone-coated self-reinforced l-lactic acid polymer urological stents. BJU International, 86, 966–969
Nickel, J. C., Grant, S. K. and Costerton, J. W. (1985). Catheter-associated bacteriuria. An experimental study. Urology, 24, 369–375
Nickel, J. C., Downey, J. and Costerton, J. W. (1989). Ultrastructural study of microbiologic colonisation of urinary catheters. Urology, 34, 284–291
Nickel, J. C., Downey, J. and Costerton, J. W. (1991). Movement of Pseudomonas aeruginosa along catheter surfaces. A mechanism in the pathogenesis of catheter-associated infection. Urology, 39, 93–98
Nickel, J. C., Downey, J. and Costerton, J. W. (1992). Movement of Pseudomonas aeruginosa along catheter surfaces. A mechanism in pathogenesis of catheter-associated infection. Urology, 39, 93–98
Nickel, J. C., Costerton, J. W., McLean, R. J. C. and Olson, M., (1994). Bacterial biofilms: influence on the pathogenesis, diagnosis and treatment of urinary tract infections. Journal of Antimicrobial Chemotherapy, 33, 31–41
Pemberton, L. B., Ross, V., Cuddy, P., Kremer, H., Fessler, T. and McGurk, E. (1996). No difference in catheter sepsis between standard and antiseptic central venous catheters. Archives of Surgery, 131, 986–989
Raad, I., Darouiche, R., Hachem, R., Mansouri, N. and Bodey, G. P. (1996). The broad-spectrum activity of catheters coated with minocycline and rifampicin. Journal of Infectious Diseases, 173, 418–424
Raad, I., Buzaid, A., Rhyne, J., Hachem, R., Darouiche, R.. (1997a). Minocycline and ethylenediaminetetraacetate for the prevention of recurrent vascular catheter infections. Clinical Infectious Diseases, 25, 149–151
Raad, I., Darouiche, R., Dupuis, J., Abi-Said, D., Gabrielli, A., Hachem, R., Wall, M., Harris, R., Jones, J., Buzaid, A., Robertson, C., Sheaq, S., Curling, P., Burke, T. and Ericsson, C., (1997b). Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonisation and bloodstream infections: a randomized, double-blind trial. Annals of Internal Medicine, 127, 267–274
Raad, I. I., Darouiche, R. O., Hachem, R., AbiSaid, D., Safar, H., Darnule, T., Mansouri, M. and Morck, D. (1998). Antimicrobial durability and rare ultrastructural colonization of indwelling central catheters coated with minocycline and rifampin. Critical Care Medicine, 26, 219–224
Rad, A. Y., Ayhan, H. and Piskin, E. (1998). Adhesion of different bacterial strains to low-temperature plasma treated biomedical silicon catheter surfaces. Journal of Bioactive and Compatible Polymers, 13, 81–101
Ramsay, J. W. A., Gernham, A. J., Mulhall, A. B.. (1999). Biofilms, bacteria and bladder catheters. British Journal of Urology, 64, 395–398
Reid, G. (1997). Microbial adhesion to biosurfaces. Current Opinion in Colloid and Interface Science, 2, 513–516
Reid, G. (1999). Biofilms in infectious disease and on medical devices. International Journal of Antimicrobial Agents, 11, 223–226
Reid, G., Tieszer, C., Foerch, R., Busscher, H. I., Khoury, A. E. and Mei, H. C. (1992a). The binding of urinary components and uropathogens to a silicone latex urethral catheter. Cells and Materials, 2, 253–260
Reid, G., Khoury, A. E., Neumann, A. W. and Bruce, A. W., (1992b). Components involved in biomaterial-related infections. American Urology Association. Updates Service, Lesson 18, 11, 138–143
Reid, G., Lam, D., Policova, Z. and Neumann, A. W. (1993). Adhesion of two uropathogens to silicone and lubricious catheters: influence of pH, urea and creatinine. Journal of Materials Science. Materials in Medicine, 4, 17–22
Reid, G., Davidson, R. and Denstedt, J. D. (1994a). Analyses of conditioning film deposition onto ureteral stents. Surface and Interface Analysis, 21, 581–586
Reid, G., Sharma, S., Advikolanu, K. and Tieszer, C. (1994b). Effects of ciprofloxacin, norfloxacin and ofloxacin on in vitro adhesion and survival of Pseudomonas aeruginosa AK. 1 on urinary catheters. Antimicrobial Agents and Chemotherapy, 38, 1490–1495
Riley, D. K., Classen, D. C., Stevens, L. E. and Burke, J. P. (1995). A large randomized clinical trial of a silver-impregnated urinary catheter: lack of efficacy and staphylococcal superinfection. American Journal of Medicine, 98, 349–356
Santin, M., Motta, A., Denyer, S. P. and Cannas, M. (1999). Effect of the urine conditioning film on ureteral stent encrustation and characterisation of its protein composition. Biomaterials, 20, 1245–1251
Schierholz, J. M., Jansen, B., Jaenicke, L. and Pulverer, G. (1994). In vitro efficacy of an antibiotic-releasing silicone ventricle catheter to prevent shunt infection. Biomaterials, 15, 996–1000
Schierholz, J. M., Steinhouser, H., Rump, A. F. E., Berkels, R. and Pulverer, G. (1997). Controlled release of antibiotics from biomedical polyurethanes. Biomaterials, 18, 839–844
Sherertz, R. J. (1997). Selected thoughts on the development of new medical devices. Current Opinion in Infectious Diseases, 10, 330–334
Sioshansi, P. and Tobin, E. J. (1996). Surface-treatment of biomaterials by ion-beam processes. Surface and Coatings Technology, 83, 175–182
Stickler, D. J. (1996). Bacterial biofilms and the encrustation of urethral catheters. Biofouling, 9, 293–305
Stickler, D. J. (2000). Biomaterials to prevent nosocomial infections: is silver the gold standard?. Current Opinion in Infectious Diseases, 13, 389–393
Stickler, D. J., King, J., Nettleton, J. and Winters, C. (1993a). The structure of urinary catheters encrusting bacterial biofilms. Cells and Materials, 3, 315–320
Stickler, D., Ganderton, L., King, J., Nettleton, J. and Winters, C. (1993b). Proteus mirabilis biofilms and the encrustation of uretheral stents. Urological Research, 21, 407–411
Stickler, D. J., Howe, N. S. and Winters, C. (1994). Bacterial biofilm growth on ciprofloxacin treated urethral catheters. Cells and Materials, 4, 387–398
Stickler, D. J., Morris, N. S. and Williams, T. J. (1996). An assessment of the ability of a silver-releasing device to prevent bacterial-contamination of urethral catheter drainage systems. British Journal of Urology, 78, 579–588
Stickler, D. J., Morris, N. S., McClean, R. J. C. and Fuqua, C. (1998). Biofilms on indwelling urinary catheters produce quorum-sensing signal molecules in situ and in vitro. Applied and Environmental Microbiology, 64, 3486–3490
Stickler, D. J. and Hughes, G. (1999). Ability of Proteus mirabilis to swarm over urethral catheters. European Journal of Clinical Microbiology and Infectious Diseases, 18, 206–208
Talja, M., Virtanen, J. and Andersson, L. C. (1986). Toxic catheter and diminished uretheral blood circulation in the induction of urethral strictures. European Urology, 12, 340–345
Tebbs, S. E., Sawyer, A. and Elliott, T. S. (1994). Influence of surface morphology on in vitro bacterial adherence to central venous catheters. British Journal of Anaesthesia, 72, 587–591
Tunney, M. M., Gorman, S. P. and Patrick, S. (1996a). Infection associated with medical devices. Reviews in Medical Microbiology, 74, 195–205
Tunney, M. M., Bonner, M. C., Keane, P. F. and Gorman, S. P. (1996b). Development of a model for assessment of biomaterial encrustation in the upper urinary tract. Biomaterials, 17, 1025–1029
Tunney, M. M., Keane, P. F., Jones, D. S. and Gorman, S. P. (1996c). Comparative assessment of ureteral stent biomaterial encrustation. Biomaterials, 17, 1541–1546
Tunney, M. M., Keane, P. F. and Gorman, S. P. (1997a). Assessment of urinary tract biomaterial encrustation using a modified Robbins device continuous flow model. Journal of Biomedical Materials Research, 38, 87–93
Tunney, M. M., Jones, D. S. and Gorman, S. P. (1997b). Methacrylate polymers and copolymers as urinary tract biomaterials: resistance to encrustation and microbial adhesion. International Journal of Pharmaceutics, 151, 121–126
Tunney, M. M., Jones, D. S. and Gorman, S. P. (1999). Biofilm and biofilm-related encrustation of urinary tract devices. In Methods in Enzymology, ed. R. Doyle, pp. 558–565. San Diego, CA: Academic Press
Loosdrecht, M. C. M., Lyklema, J., Norde, W. and Zehnder, A. J. B. (1990). Influence of interfaces on microbal activity. Microbiological Reviews, 54, 75–87
Wassall, M. A., Santin, M., Isalberti, C., Cannas, M. and Denyer, S. P. (1997). Adhesion of bacteria to stainless steel and silver-coated orthopaedic external fixation pins. Journal of Biomedical Materials Research, 36, 325–330
Whalen, R. L., Cai, C., Thompson, L. M., Sarrasin, M. J.. (1997). An infection inhibiting urinary catheter material. ASAIO Journal, 43, M843–M847
Wollin, T. A., Tieszer, C., Riddell, J. V., Denstedt, J. D., and Reid, G. (1998). Bacterial biofilm formation, encrustation, and antibiotic adsorption to ureteral stents indwelling in humans. Journal of Endourology, 12, 101–111
Woodyard, L. L., Bowersock, T. L., Turek, J. J., McCabe, G. P. and Deford, J. A. (1996). Comparison of the effects of several silver-treated intravenous catheters on the survival of staphylococci in suspension and their adhesion to the catheter surface. Journal of Controlled Release, 40, 23–30