High-resolution imaging reveals microbial biofilms on patient urinary catheters despite antibiotic administration

  • Jennifer N. Walker
  • Ana L. Flores-Mireles
  • Aaron J. L. Lynch
  • Chloe Pinkner
  • Michael G. Caparon
  • Scott J. Hultgren
  • Alana DesaiEmail author
Original Article



Catheter-associated urinary tract infections (CAUTIs) are a significant cause of morbidity worldwide, as they account for 40% of all hospital-associated infections. Microbial biofilm formation on urinary catheters (UCs) limits antibiotic efficacy, making CAUTI extremely difficult to treat. To gain insight into the spatiotemporal microbe interactions on the catheter surface we sought to determine how the presence or absence of bacteriuria prior to catheterization affects the organism that ultimately forms a biofilm on the UC and how long after catheterization they emerge.


Thirty UCs were collected from patients who received a urine culture prior to catheterization, a UC, and antibiotics as part of standard of care. Immunofluorescence imaging and scanning electron microscopy were used to visualize patient UCs.


Most patients did not have bacteria in their urine (based on standard urinalysis) prior to catheterization, yet microbes were detected on the majority of UCs, even with dwell times of < 3 days. The most frequently identified microbes were Staphylococcus epidermidis, Enterococcus faecalis, and Escherichia coli.


This study indicates that despite patients having negative urine cultures and receiving antibiotics prior to catheter placement, microbes, including uropathogens associated with causing CAUTI, could be readily detected on UCs with short dwell times. This suggests that a potential microbial catheter reservoir can form soon after placement, even in the presence of antibiotics, which may serve to facilitate the development of CAUTI. Thus, removing and/or replacing UCs as soon as possible is of critical importance to reduce the risk of developing CAUTI.


Urinary catheterization CAUTI Microbial biofilms Catheter colonization Asymptomatic catheter-associated bacteriuria 



We thank our clinical coordinators, Aleksandra Klim and Karla Bergeron.

Author contributions

JNW: project development, data collection, data analysis, and manuscript writing and editing. ALF-M: project development, data collection, data analysis, and manuscript writing and editing. AJLL: data collection and data analysis. CP: data collection and data analysis. MGC: project development and manuscript writing and editing. SJH: project development and manuscript writing and editing. AD: project development and manuscript writing and editing.


This work was supported by the 1F32DK104516-01 Grant to ALFM and the R01-DK051406 and the R01-AI108749-01 Grants to JNW, ALFM, AJLL, CP, MGC, and SJH from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Institute of Allergy and Infectious Diseases (NIAID).

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflicts of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of Washington University School of Medicine (WUSM) Internal Review Board (approval #201410058) and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

345_2019_3027_MOESM1_ESM.pdf (127 kb)
Supplementary file1 (PDF 126 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Molecular MicrobiologyWashington University School of MedicineSt. LouisUSA
  2. 2.Center for Women’s Infectious Disease ResearchWashington University School of MedicineSt. LouisUSA
  3. 3.Division of Urologic Surgery, Department of SurgeryWashington University School of MedicineSt. LouisUSA
  4. 4.Department of Biological SciencesUniversity of Notre DameNotre DameUSA

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