Influence of biofilms on morbidity associated with short-term indwelling ureteral stents: a prospective observational study
- 38 Downloads
To evaluate the influence of biofilms on morbidity associated with short-term ureteral stenting using contemporary methods of biofilm examination and validated assessment of symptoms.
Patients undergoing temporary ureteral stenting for secondary ureterorenoscopy due to urinary calculi were prospectively included. The German Ureteral Stent Symptoms Questionnaire (USSQ) was used to assess stent-associated morbidity. Biofilms were removed from stents using ‘pinhole extraction’, a novel, validated, abrasion-based technique. Extracted biofilms were analyzed for total mass, bacterial load and mineral components. Correlation between total biofilm mass and USSQ total score was the primary outcome variable analyzed using Spearman correlation. Secondary outcomes included correlations between various biofilm characteristics and symptoms.
94 patients were included in the analysis. Extracted biofilm mass had a median of 37.0 mg (0–310.2 mg) per stent. No correlation between total biofilm mass and USSQ total score was found (Spearman r = 0.012; p = 0.911). Correlations between biofilm characteristics and morbidity were generally weak and not significant. Significant correlations could be found between biofilm mass and hematuria (r = 0.280; p = 0.007), and between the number of bacteria (qPCR) and the USSQ subscore for pain (r = 0.243; p = 0.019) and the intake of analgesics (r = 0.259; p = 0.012).
Based on elaborated biofilm examination methods and validated self-reported outcome measures, our findings indicate that biofilms might aggravate some lower urinary tract symptoms but are not the main trigger for stent-associated morbidity in short-term ureteral stenting.
KeywordsUreteral stent Biofilm Morbidity Ureteral Stent Symptoms Questionnaire USSQ Symptoms
The authors would like to thank Alistair Reeves for editing the manuscript, Luzia Wiesli for technical assistance, and Antonia Neels for support with XRD analyses.
PB protocol/project development, data collection and management, data analysis, manuscript writing. VZ protocol/project development, data collection and management, data analysis, manuscript writing. MTB protocol/project development, data collection and management, data analysis, manuscript writing. WCA protocol/project development, data analysis, manuscript writing. ON protocol/project development, data analysis, manuscript writing. SG data analysis, manuscript writing. H-PS protocol/project development, manuscript writing. QR protocol/project development, data analysis, manuscript writing. DA protocol/project development, data collection and management, data analysis, manuscript writing.
The study was supported by an internal grant of Cantonal Hospital St. Gallen and the Swiss Federal Laboratories for Materials Science and Technology (Empa/KSSG 15/12).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 10.Chromek M, Slamova Z, Bergman P, Kovacs L, Podracka L, Ehren I, Hokfelt T, Gudmundsson GH, Gallo RL, Agerberth B, Brauner A (2006) The antimicrobial peptide cathelicidin protects the urinary tract against invasive bacterial infection. Nat Med 12(6):636–641. https://doi.org/10.1038/nm1407 CrossRefPubMedGoogle Scholar
- 11.Poljakovic M, Svensson ML, Svanborg C, Johansson K, Larsson B, Persson K (2001) Escherichia coli-induced inducible nitric oxide synthase and cyclooxygenase expression in the mouse bladder and kidney. Kidney Int 59(3):893–904. https://doi.org/10.1046/j.1523-1755.2001.059003893.x CrossRefPubMedGoogle Scholar
- 13.Bonkat G, Rieken M, Muller G, Roosen A, Siegel FP, Frei R, Wyler S, Gasser T, Bachmann A, Widmer AF (2013) Microbial colonization and ureteral stent-associated storage lower urinary tract symptoms: the forgotten piece of the puzzle? World J Urol 31(3):541–546. https://doi.org/10.1007/s00345-012-0849-6 CrossRefPubMedGoogle Scholar
- 15.EAU Guidelines on Urological Infections. http://uroweb.org/guideline/urological-infections/. Accessed June 2016
- 16.Buhmann MT, Abt D, Altenried S, Rupper P, Betschart P, Zumstein V, Maniura-Weber K, Ren Q (2018) Extraction of biofilms from ureteral stents for quantification and cultivation-dependent and -independent analyses. Front Microbiol 9:1470. https://doi.org/10.3389/fmicb.2018.01470 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Grazulis S, Daskevic A, Merkys A, Chateigner D, Lutterotti L, Quiros M, Serebryanaya NR, Moeck P, Downs RT, Le Bail A (2012) Crystallography Open Database (COD): an open-access collection of crystal structures and platform for world-wide collaboration. Nucleic Acids Res 40 (Database Issue):D420–427. https://doi.org/10.1093/nar/gkr900
- 23.Minardi D, Montanari MP, Tili E, Cochetti I, Mingoia M, Varaldo PE, Muzzonigro G (2008) Effects of fluoroquinolones on bacterial adhesion and on preformed biofilm of strains isolated from urinary double J stents. J Chemother 20(2):195–201. https://doi.org/10.1179/joc.2008.20.2.195 CrossRefPubMedGoogle Scholar