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Updated: Nov 28, 2025
An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection
Published on: June 24, 2025
A Glance at Antimicrobial Strategies to Prevent Catheter-Associated Medical Infections
Susana I C Ricardo1, Inês I L Anjos2, Nuno Monge3
1Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisboa, Portugal.
Abstract:
Urinary and intravascular catheters are two of the most used invasive medical devices; however, microbial colonization of catheter surfaces is responsible for most healthcare-associated infections (HAIs). Several antimicrobial-coated catheters are available, but recurrent antibiotic therapy can decrease their potential activity against resistant bacterial strains. The aim of this Review is to question the actual effectiveness of currently used (coated) catheters and describe the progress and promise of alternative antimicrobial coatings. Different strategies have been reviewed with the common goal of preventing biofilm formation on catheters, including release-based approaches using antibiotics, antiseptics, nitric oxide, 5-fluorouracil, and silver as well as contact-killing approaches employing quaternary ammonium compounds, chitosan, antimicrobial peptides, and enzymes. All of these strategies have given proof of antimicrobial efficacy by modifying the physiology of pathogens or disrupting their structural integrity. The aim for synergistic approaches using multitarget processes and the combination of both antifouling and bactericidal properties holds potential for the near future. Despite intensive research in biofilm preventive strategies, laboratorial studies still present some limitations since experimental conditions usually are not the same and also differ from biological conditions encountered when the catheter is inserted in the human body. Consequently, in most cases, the efficacy data obtained from in vitro studies is not properly reflected in the clinical setting. Thus, further well-designed clinical trials and additional cytotoxicity studies are needed to prove the efficacy and safety of the developed antimicrobial strategies in the prevention of biofilm formation at catheter surfaces.
Insights
Antimicrobial coatings on catheters show promise in preventing healthcare-associated infections (HAIs). However, laboratory findings on these novel strategies, including release-based and contact-killing approaches, need further clinical validation for real-world effectiveness.
Area of Science:
- Biomedical Engineering
- Infectious Diseases
- Materials Science
Background:
- Urinary and intravascular catheters are crucial invasive medical devices, but their surfaces are prone to microbial colonization, leading to healthcare-associated infections (HAIs).
- Existing antimicrobial-coated catheters face challenges, as repeated antibiotic use can reduce efficacy against resistant bacteria.
- The effectiveness of current coated catheters is questioned, necessitating exploration of alternative antimicrobial strategies.
Purpose of the Study:
- To evaluate the actual effectiveness of currently used antimicrobial-coated catheters.
- To review the progress and potential of alternative antimicrobial coatings for preventing catheter-related infections.
- To highlight the need for improved strategies beyond conventional antibiotic therapies.
Main Methods:
- Review of diverse antimicrobial coating strategies, including release-based (antibiotics, antiseptics, nitric oxide, 5-fluorouracil, silver) and contact-killing (quaternary ammonium compounds, chitosan, antimicrobial peptides, enzymes) approaches.
- Analysis of studies demonstrating antimicrobial efficacy through pathogen physiology modification or structural disruption.
- Examination of synergistic approaches combining antifouling and bactericidal properties.
Main Results:
- Various antimicrobial strategies have demonstrated efficacy in preventing biofilm formation by impacting microbial physiology and integrity.
- Synergistic approaches utilizing multitarget processes and combining antifouling with bactericidal properties show future potential.
- Significant limitations exist in translating laboratory findings to clinical settings due to differing experimental and biological conditions.
Conclusions:
- Novel antimicrobial coatings offer promising avenues for preventing catheter-associated biofilm formation and infections.
- Further well-designed clinical trials are essential to validate the efficacy and safety of these strategies in real-world patient care.
- Cytotoxicity studies are also required to ensure the safety of developed antimicrobial coatings before widespread clinical adoption.
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