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Evaluation of PEG-based Antimicrobial Coatings on Urinary Catheters in the Prevention of E. coli Infections in a Rabbit Model.

Introduction and Objective Catheter associated urinary tract infections (CAUTI) are a major cause of patient morbidity and mortality. Despite many attempts to design biomaterials that might reduce the risk, none have had a profound impact on reducing the incidence of this most common nosocomial infection. Recent in vitro work, however, has shown promise for a silver-based biomaterial coating composed of polyethylene glycol (mPEG-DOPA3) in reducing uropathogen attachment and biofilm formation. The aim of this work was to investigate whether these results translate into a meaningful impact on infection development and bacterial adherence in an in vivo rabbit model. Materials and Methods New Zealand white rabbits were randomized into groups of 12 and had the following catheters inserted: Group1- uncoated polyurethane, Group 2- Coating A (mPEG-DOPA3 + 2 mg/mL AgNO3) and Group 3- Coating B (mPEG-DOPA3 + 10 mg/mL AgNO3). Each rabbit was challenged with 108 colony forming units (CFU) of E. coli GR-12 instilled directly into the bladder at the time of catheter insertion and urine was monitored over 7 days for bacterial counts. Catheters were retrieved and evaluated for encrustation and attachment analysis, and tissues collected for histopathological characterization and bacterial invasion. Results Urinary bacterial colony counts were lower among rabbits in the Coating A group vs controls (4/11 vs 10/12, respectively) (p=0.029), and there were fewer rabbits with invasive infections (3/12 vs 9/12, p=0.02). More encrustation was observed among animals in the Coating B group vs controls (7.22 vs 2.69 mg/cm2, p=0.033). There were no significant differences in tissue effects between groups. Conclusions The use of a mPEG-DOPA3 urinary catheter coating effectively reduced urinary pathogen counts, while not causing adverse tissue effects in this model. Further clinical evaluation is warranted.