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Macromol Biosci. 2019 May;19(5):e1800384. doi: 10.1002/mabi.201800384. Epub 2019 Mar 18.

Evaluating Efficacy of Antimicrobial and Antifouling Materials for Urinary Tract Medical Devices: Challenges and Recommendations.

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Department of Chemistry, Umeå University, 901 87, Umeå, Sweden.
Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-004, Lisbon, Portugal.
Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 81499, Bratislava 1, Slovakia.
Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE), Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal.
Department of Environmental Health, Research and Development Unit, National Institute of Health Dr. Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisbon, Portugal.
BioModics ApS, Stengårds Alle 31A, DK-2800, Lyngby, Denmark.
Department of Biology, University of Copenhagen, 2100, Copenhagen, Denmark.
Department of Polymers, University of Chemical Technology and Metallurgy (UCTM), 8 Kliment Ohridski Blvd, 1756, Sofia, Bulgaria.
Department of Medical Microbiology, School of Medicine, Koc University, 34450, Sariyer, Istanbul, Turkey.
Institute of Chemistry and the Center for Nanoscience and Nanotechnology, The Hebrew University of Jerusalem, Jerusalem, 91904, Israel.
Department of Medical Microbiology, Amsterdam UMC, Amsterdam Infection and Immunity Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
3B's Research Group, I3Bs Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Guimarães, 4710-057, Braga, Portugal.
Department of Mining-Metallurgy Engineering and Materials Science, POLYMAT, School of Engineering, University of the Basque Country, 48940 Leina, Bizkaia, Bilbao, Spain.
Biofilmcenter, Department of Microbiology, Infectious Diseases and Immunology, Charité University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
University of Groningen, University Medical Center Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.


In Europe, the mean incidence of urinary tract infections in intensive care units is 1.1 per 1000 patient-days. Of these cases, catheter-associated urinary tract infections (CAUTI) account for 98%. In total, CAUTI in hospitals is estimated to give additional health-care costs of £1-2.5 billion in the United Kingdom alone. This is in sharp contrast to the low cost of urinary catheters and emphasizes the need for innovative products that reduce the incidence rate of CAUTI. Ureteral stents and other urinary-tract devices suffer similar problems. Antimicrobial strategies are being developed, however, the evaluation of their efficacy is very challenging. This review aims to provide considerations and recommendations covering all relevant aspects of antimicrobial material testing, including surface characterization, biocompatibility, cytotoxicity, in vitro and in vivo tests, microbial strain selection, and hydrodynamic conditions, all in the perspective of complying to the complex pathology of device-associated urinary tract infection. The recommendations should be on the basis of standard assays to be developed which would enable comparisons of results obtained in different research labs both in industry and in academia, as well as provide industry and academia with tools to assess the antimicrobial properties for urinary tract devices in a reliable way.


antimicrobial; device-associated urinary tract infections; in vitro; in vivo; material testing

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