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Solidago, orthosiphon, birch and cranberry extracts can decrease microbial colonization and biofilm development in indwelling urinary catheter: a microbiologic and ultrastructural pilot study

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Abstract

Purpose

Plants extracts are used in urology to manage urinary tract infections. We aimed to evaluate the efficacy of a preparation with solidago, orthosiphon, birch and cranberry extracts (CISTIMEV PLUS®) in reducing microbial colonization and biofilm development in patients with indwelling urinary catheters.

Methods

All consecutive outpatients attending our department between January and June 2010 for the substitution of indwelling catheters were considered for this single-blinded, randomized and controlled pilot study to test superiority of the preventative management (CISTIMEV PLUS®, 1 tablet daily for 30 days) in respect to no treatment. A sample size of 10–40 participants per group was considered adequate. All patients underwent urine culture the same day of the catheter substitution and were then randomized into test group (n = 48) and control group (n = 35). Ultrastructural analysis was also performed. After 30 days, the catheter was replaced and the analysis repeated. The primary outcome was the rate of positive urinary culture at the end of the entire study period.

Results

Ten patients abandoned the study. At 30 days, according to per-protocol analysis, the groups statistically differed regarding the rate of positive urine cultures: test group 10/43 and control group 16/30 (p = 0.013) (−30.1 % [95 % CI −51.94 to −8.21]). The most common isolated bacteria were Escherichia coli and Enterococcus faecalis.

Conclusions

The use of solidago, orthosiphon, birch and cranberry extracts resulted in a significant reduction of microbial colonization in patients with indwelling urinary catheters. Larger clinical trials are needed to demonstrate that the effects here reported are sufficient to reduce symptomatic catheter-associated urinary tract infections.

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Acknowledgments

The authors wish to acknowledge FarmaceuticaMEV, Siena, Italy for providing CISTIMEV PLUS® used in the study. Special thanks to Professor John Denton for manuscript language revision and to all the members of the Santa Chiara Regional Hospital, Department of Urology, for assistance in sample collection.

Conflict of interest

All authors declare no financial/commercial conflicts of interest.

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Authors and Affiliations

  1. Department of Urology, Santa Chiara Regional Hospital, Largo Medaglie d’Oro, 9, Trento, Italy

    Tommaso Cai, Carolina D’Elia & Gianni Malossini

  2. Department of Laboratory Medicine, Santa Chiara Regional Hospital, Trento, Italy

    Iole Caola, Federico Piccoli & Patrizio Caciagli

  3. Department of Industrial Technologies, BIOtech Centre on Biomedical Technologies, University of Trento, Trento, Italy

    Francesco Tessarolo & Giandomenico Nollo

  4. Department of Pathology, University of Florence, Florence, Italy

    Gabriella Nesi

  5. Sexually Transmitted Diseases Centre, Santa Maria Annunziata Hospital, Florence, Italy

    Sandra Mazzoli

  6. Department of Urology, University of Florence, Florence, Italy

    Riccardo Bartoletti

Authors
  1. Tommaso Cai
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  2. Iole Caola
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  3. Francesco Tessarolo
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  11. Riccardo Bartoletti
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Correspondence to Tommaso Cai.

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Cai, T., Caola, I., Tessarolo, F. et al. Solidago, orthosiphon, birch and cranberry extracts can decrease microbial colonization and biofilm development in indwelling urinary catheter: a microbiologic and ultrastructural pilot study. World J Urol 32, 1007–1014 (2014). https://doi.org/10.1007/s00345-013-1173-5

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  • DOI: https://doi.org/10.1007/s00345-013-1173-5

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