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Published on: June 24, 2025
Evaluating Efficacy of Antimicrobial and Antifouling Materials for Urinary Tract Medical Devices: Challenges and
Madeleine Ramstedt1, Isabel A C Ribeiro2, Helena Bujdakova3
1Department of Chemistry, Umeå University, 901 87, Umeå, Sweden.
Insights
Catheter-associated urinary tract infections (CAUTI) are a major problem in hospitals, costing billions. This review offers recommendations for testing antimicrobial urinary tract devices to reduce CAUTI incidence.
Area of Science:
- Biomedical Engineering
- Infectious Diseases
- Materials Science
Background:
- Urinary tract infections (UTIs) are common in intensive care units, with catheter-associated UTIs (CAUTI) comprising 98% of cases.
- CAUTI incurs significant healthcare costs, highlighting the need for innovative solutions beyond basic urinary catheters.
- Existing antimicrobial strategies for urinary tract devices face challenges in efficacy evaluation.
Purpose of the Study:
- To provide comprehensive considerations and recommendations for testing antimicrobial properties of urinary tract devices.
- To address the complex pathology of device-associated urinary tract infections.
- To establish standardized assays for reliable comparison of results across research labs and industry.
Main Methods:
- Review of standard assays for antimicrobial material testing.
- Consideration of surface characterization, biocompatibility, and cytotoxicity.
- Inclusion of in vitro and in vivo testing, microbial strain selection, and hydrodynamic conditions.
Main Results:
- Identified key aspects for evaluating antimicrobial efficacy in urinary tract devices.
- Highlighted the need for standardized testing protocols to ensure reliable and comparable results.
- Provided a framework for assessing device-associated urinary tract infection mitigation strategies.
Conclusions:
- Standardized antimicrobial material testing is crucial for developing effective urinary tract devices.
- Reliable assessment tools are needed for both industry and academia to combat CAUTI.
- This review offers a pathway towards reducing the incidence of device-associated UTIs through improved material evaluation.
Abstract:
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.
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