Article

OBJECTIVES: To review the literature showing that understanding how Foley
catheters become encrusted and blocked by crystalline bacterial biofilms has led
to strategies for the control of this complication in the care of patients
undergoing long-term indwelling bladder catheterization.
A comprehensive
PubMed search of the literature published between 1980 and December 2009 was made
for relevant articles using the Medical Subject Heading terms 'biofilms',
'urinary catheterization', 'catheter-associated urinary tract infection' and
'urolithiasis'. Papers on catheter-associated urinary tract infections and
bacterial biofilms collected during 40 years of working in the field were also
reviewed. RESULTS: There is strong experimental and epidemiological evidence that
infection by Proteus mirabilis is the main cause of the crystalline biofilms that
encrust and block Foley catheters. The ability of P. mirabilis to generate
alkaline urine and to colonize all available types of indwelling catheters allows
it to take up stable residence in the catheterized tract in bladder stones and
cause recurrent catheter blockage. CONCLUSION: The elimination of P. mirabilis by
antibiotic therapy as soon as it appears in the catheterized urinary tract could
improve the quality of life for many patients and reduce the current expenditure
of resources when managing the complications of catheter encrustation and
blockage. For patients who are already chronic blockers and stone formers,
antibiotic treatment is unlikely to be effective owing to the resistance of cells
in the crystalline biofilms. Strategies such as increasing fluid intake with
citrated drinks could control the problem until bladder stone removal can be organized.

Langue : ANGLAIS