Assessment of the Complexity of Preventing Catheter-Associated Urinary Tract Infection and Bacterial Biofilms
Main Article Content
Abstract
Catheter-associated urinary tract infections (CAUTI) are among the most common healthcare-associated infections, arising from biofilm-forming bacteria and cause increased morbidity, mortality, length of stay and hospital costs.
The linear model of the microbial theory of disease has failed to solve CAUTI. It was hoped that, knowing the nosological diagnosis (urinary tract infection), the cause (bacteria) and its treatment (antibiotic), the cure would be simple.
However, the prevention and treatment of CAUTI imposes challenges, which can only be addressed, if it is understood that CAUTI is a complex entity where different actors and multiple factors interact, in various settings.
The objective of this article is to review the intervention of different actors and elements in the prevention of CAUTI, focusing on the assessment of the complexity of preventing CAUTI and bacterial biofilm.
The unnecessary use of indwelling urethral catheter is the primary risk factor for CAUTI, so the use of the catheter with appropriate indications, its proper insertion and maintenance, and its rapid removal are recommended.
In selected patients, alternatives to indwelling urethral catheterization, such as the male external catheter and the prostatic stent, may be considered, although they are not without complications.
The health care setting should be considered in the design of prevention strategies. CAUTIs in intensive care units are associated with increased lengths of stay, healthcare costs and antibiotic resistance development.
In the twenty-first century, the proportion of older people tends to increase globally, which adds value to the fact that elder age is a significant risk factor for CAUTI.
Biofilm is the central factor in the pathogenesis of CAUTI. Various antibiofilm strategies have been designed because once biofilms are formed, they are difficult to treat. Biomedical technology continuously introduces new antifouling and antibacterial materials for urethral catheter coating. The efficiency of the different coatings is proven in vitro, in animal models, and clinical trials. However, its application in clinical settings has not been satisfactory.
Education should include both patients and their families and/or caregivers as well as health personnel. Patient and family participation is necessary in the patient’s care. It is important to consider the values, attitudes, and beliefs of health personnel, which will impact clinical practice.
The overload of work of health personnel and inadequate and/or insufficient infrastructure are added as barriers to adherence to prevention recommendations.
Therefore, it is necessary to address and optimize the complexity of CAUTI care, through a multimodal and multidisciplinary intervention, which minimizes its incidence and complication.
Article Details
How to Cite
LEIVA, Jose Luis Amorone et al.
Assessment of the Complexity of Preventing Catheter-Associated Urinary Tract Infection and Bacterial Biofilms.
Medical Research Archives, [S.l.], v. 13, n. 9, sep. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6951>. Date accessed: 06 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i9.6951.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. anafy HM, Saad SM, Al-Ghorab MM. Ancient Egyptian medicine: contribution to urology. Urology. 1974 Jul;4(1):114-20.
2. Saint S, Trautner BW, Fowler KE, Colozzi J, Ratz D, Lescinskas E, Hollingsworth JM, Krein SL. A Multicenter Study of Patient-Reported Infectious and Noninfectious Complications Associated With Indwelling Urethral Catheters. JAMA Intern Med. 2018 Aug 1;178(8):1078-1085
3. Saint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control. 2000 Feb;28(1):68-75.
4. Grand View Research. Medical Devices. Urinary Catheters Market Size. Share & Trends Report, 2030. Report ID: GVR-1-68038-381-2. Available at: https://www.grandviewresearch.com/industry-analysis/urinary-catheters-market
5. Klevens RM, Edwards JR, Richards CL,Jr, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122(2):160-166.
6. Centers for Disease Control and Prevention. Guideline for prevention of catheter-associated urinary tract infections (2009). January 2025. Available at: https://www.cdc.gov/infection-control/hcp/cauti/background.html?CDC_AAref_Val=https://www.cdc.gov/infectioncontrol/guidelines/cauti/background.html
7. European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines. Kranz, Jennifer et al. European Urology, Volume 86, Issue 1, 27 – 41.
8. Rosenthal VD, Memish ZA, Nicastri E, Leone S, Bearman G. Preventing catheter-associated urinary tract infections: A position paper of the International Society for Infectious Diseases, 2024 update. Int J Infect Dis. 2025 Feb;151:107304.
9. Stone PW. Economic burden of healthcare-associated infections: an American perspective. Expert Rev Pharmacoecon Outcomes Res 2009; 9 :417–22. doi: 10. 1586/erp.09.53.
10. Patel PK, Advani SD, Kofman AD, et al. Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology. 2023;44(8):1209-1231.
11. National Institute for Health and Care Excellence (NICE). Infection prevention and control. QS61. April 2014. Available at: https://www.nice.org.uk/guidance/qs61
12. Reid, S., Brocksom, J., Hamid, R., Ali, A., Thiruchelvam, N., Sahai, A., Harding, C., Biers, S., Belal, M., Barrett, R., Taylor, J. and Parkinson, R. (2021), British Association of Urological Surgeons (BAUS) and Nurses (BAUN) consensus document: management of the complications of long-term indwelling catheters. BJU Int, 128: 667-677.
13. Kranz J, Bartoletti R, Bruyère F, Cai T, Geerlings S, Köves B, Schubert S, Pilatz A, Veeratterapillay R, Wagenlehner FME, Bausch K, Devlies W, Horváth J, Leitner L, Mantica G, Mezei T, Smith EJ, Bonkat G. European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines. Eur Urol. 2024 Jul;86(1):27-41.
14. The European Association of Urology Nurses (EAUN). V. Geng (Chair), H. Lurvink, I. Pearce, S. Vahr Lauridsen. Guideline Indwelling catheterisation in adults – Urethral and suprapubic. 2024 (online) Available at: https://nurses.uroweb.org/guideline/indwelling-catheterisation-in-adults-urethral-and-suprapubic/
15. Amorone Leiva JL, María Agüero D, Caballero González C, Cecilia Postiglione M. Necrosis total de pene por cuidado inapropiado del colector urinario externo [Total penile necrosis due to inappropriate care of condom catheter]. Rev Esp Geriatr Gerontol. 2019 Jan-Feb;54(1):57-58.
16. Amorone Leiva JL, Puscinski AJ. Recomendaciones para el tratamiento de LUTS por HPB. 2012.Rev. Arg. de Urol. Vol. 77 (Suplemento 1).
17. Puscinski AJ, Amorone JL. Implante de Prótesis y Biomateriales en Urología. 2013. ISBN 9789872731991. NLM ID: 101660531.
18. Werneburg GT. Catheter-Associated Urinary Tract Infections: Current Challenges and Future Prospects. Res Rep Urol. 2022 Apr 4;14:109-133.
19. Chant C, Smith OM, Marshall JC, Friedrich JO. Relationship of catheter-associated urinary tract infection to mortality and length of stay in critically ill patients: a systematic review and meta-analysis of observational studies. Crit Care Med. Number2011;39(5):1167–1173.
20. Peng D, Li X, Liu P, et al. Epidemiology of pathogens and antimicrobial resistance of catheter-associated urinary tract infections in intensive care units: a systematic review and meta-analysis. Am J Infect Control. 2018;46(12):e81–e90.
21. Stevenson KB, Moore J, Colwell H, Sleeper B. Standardized infection surveillance in long-term care interfacility comparisons from a regional cohort of facilities. Infect Cont Hosp Epidemiol. 2005;26(3):231–238.
22. Rinke ML, Oyeku SO, Heo M, Saiman L, Zachariah P, Rosenberg RE, DeLaMora P, Rabin B, Mirhaji P, Klein E, Ford WJH, Obaro-Best O, Drasher M, Peshansky A, Balem KA, Bundy DG. Pediatric ambulatory catheter-associated urinary tract infections (CAUTIs): Incidence, risk factors, and patient outcomes. Infect Control Hosp Epidemiol. 2020 Aug;41(8):891-899.
23. Tandogdu Z, Wagenlehner FM. Global epidemiology of urinary tract Infections. Curr Opin Infect Dis. 2016;29(1):73–9.
24. Zilberberg MD, Nathanson BH, Sulham K, Shorr AF. Descriptive epidemiology and outcomes of hospitalizations with complicated urinary tract Infections in the United States, 2018. Open Forum Infect Dis. 2022;9(1):ofab591.
25. Redder JD, Leth RA, Moller JK. Analysing risk factors for urinary tract Infection based on automated monitoring of hospital-acquired Infection. J Hosp Infect. 2016;92(4):397–400.
26. Detweiler K, Mayers D, Fletcher SG. Bacteruria and urinary tract Infections in the Elderly. Urol Clin North Am. 2015;42(4):561–8.
27. Shen L, Fu T, Huang L, Sun H, Wang Y, Sun L, Lu X, Zhang J, Yang Z, Ni C. 7295 elderly hospitalized patients with catheter-associated urinary tract infection: a case-control study. BMC Infect Dis. 2023 Nov 24;23(1):825.
28. Mack WN, Mack JP, Ackerson AO. Microbial film development in a trickling filter. 1975, Volume 2, Issue 3, pp 215–226.
29. Costerton, J.W.; Geesey, G.G.; Cheng, K.J. How bacteria stick. Sci. Am. 1978, 238, 86–95.
30. Costerton, J.W.; Stewart, P.S.; Greenberg, E.P. Bacterial biofilms: A common cause of persistent infections. Science 1999, 284, 1318–1322.
31. Center for Biofilm Engineering. Biofilm Basics. Brief history of biofilm. Available at: https://biofilm.montana.edu/biofilm-basics/brief-history-biofilm.html
32. Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev. 2002 Apr;15(2):167-93. doi: 10.1128/CMR.15.2.167-193.2002.
33. Bouhrour N, Nibbering PH, Bendali F. Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens. Pathogens. 2024 May 8;13(5):393.
34. EClinicalMedicine. Antimicrobial resistance: a top ten global public health threat. EClinicalMedicine. 2021 Nov 24;41:101221.
35. Yuan L, Straub H, Shishaeva L, Ren Q. Microfluidics for Biofilm Studies. Annu Rev Anal Chem (Palo Alto Calif). 2023 Jun 14;16(1):139-159.
36. Clarke OE, Bennett V, Jones BV. An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection. J Vis Exp. 2025 Jun 24;(220).
37. Muraveva, V., Lomadze, N., Gordievskaya, Y.D. et al. Manipulation of artificial and living small objects by light driven diffusioosmotic flow. Sci Rep 14, 18342 (2024). https://doi.org/10.1038/s41598-024-69001-6
38. Stewart E, Hochstedler-Kramer BR, Khemmani M, Clark NM, Parada JP, Farooq A, Doshi C, Wolfe AJ, Albarillo FS. Characterizing the urobiome in geriatric males with chronic indwelling urinary catheters: an exploratory longitudinal study. Microbiol Spectr. 2024 Nov 5;12(11):e0094124.
39. Francolini I, Vuotto C, Piozzi A, Donelli G. Antifouling and antimicrobial biomaterials: an overview. APMIS. 2017 Apr;125(4):392-417.
40. Li C, Gao D, Li C, Cheng G, Zhang L. Fighting against biofilm: The antifouling and antimicrobial material. Biointerphases. 2024 Jul 1;19(4):040802.
41. Zhang Q, Zong Q, Feng X, Luo M, Sun W, Zhai Y. Antibacterial and antifouling materials for urinary catheter coatings. Acta Biomater. 2025 Jan 15;192:28-47.
42. Andersen MJ, Flores-Mireles AL. Urinary Catheter Coating Modifications: The Race against Catheter-Associated Infections. Coatings. 2020; 10(1):23.
43. Sharma S, Mohler J, Mahajan SD, Schwartz SA, Bruggemann L, Aalinkeel R. Microbial Biofilm: A Review on Formation, Infection, Antibiotic Resistance, Control Measures, and Innovative Treatment. Microorganisms. 2023 Jun 19;11(6):1614. doi: 10.3390/microorganisms11061614. Erratum in: Microorganisms. 2024 Sep 27;12(10):1961.
44. Wang L, Zhang S, Keatch R, Corner G, Nabi G, Murdoch S, Davidson F, Zhao Q. In-vitro antibacterial and anti-encrustation performance of silver-polytetrafluoroethylene nanocomposite coated urinary catheters. J Hosp Infect. 2019 Sep;103(1):55-63.
45. Arunachalam KD, Annamalai SK, Hari S. One-step green synthesis and characterization of leaf extract-mediated biocompatible silver and gold nanoparticles from Memecylon umbellatum. Int J Nanomedicine. 2013;8:1307-15.
46. Malka E, Perelshtein I, Lipovsky A, Shalom Y, Naparstek L, Perkas N, Patick T, Lubart R, Nitzan Y, Banin E, Gedanken A. Eradication of multi-drug resistant bacteria by a novel Zn-doped CuO nanocomposite. Small. 2013 Dec 9;9(23):4069-76.
47. Folawewo AD, Bala MD. Nanocomposite Zinc Oxide-Based Photocatalysts: Recent Developments in Their Use for the Treatment of Dye-Polluted Wastewater. Water. 2022; 14(23):3899. https://doi.org/10.3390/w14233899
48. Yan P, Chen D, Muhammad S, Guo Y, Gao Q, Niu B, Liu Y, Liu C. Carboxymethyl chitosan-immobilized silver nanoparticles for intravesical instillation: A strategy to prevent catheter-associated urinary tract infections. Int J Biol Macromol. 2025 Jul 14;320(Pt 4):146001.
49. Mosayyebi A, Manes C, Carugo D, Somani BK. Advances in Ureteral Stent Design and Materials. Curr Urol Rep. 2018 Apr 10;19(5):35.
50. Diaz Blanco C, Ortner A, Dimitrov R, Navarro A, Mendoza E, Tzanov T. Building an antifouling zwitterionic coating on urinary catheters using an enzymatically triggered bottom-up approach. ACS Appl Mater Interfaces. 2014 Jul 23;6(14):11385-93.
51. Lipovsky A, Thallinger B, Perelshtein I, Ludwig R, Sygmund C, Nyanhongo G, et al. Ultrasound coating of polydimethylsiloxanes with antimicrobial enzymes. Journal of Materials Chemistry B. 2015;3(35):7014-9.
52. Snarr BD, Baker P, Bamford NC, Sato Y, Liu H, Lehoux M, Gravelat FN, Ostapska H, Baistrocchi SR, Cerone RP, Filler EE, Parsek MR, Filler SG, Howell PL, Sheppard DC. Microbial glycoside hydrolases as antibiofilm agents with cross-kingdom activity. Proc Natl Acad Sci U S A. 2017 Jul 3;114(27):7124-7129.
53. Bell MM, Alaestante G, Finch C. A multidisciplinary approach to preventing catheter-associated urinary tract infections through education, care continuity, and system-wide support. 2016. Ochsner Journal 16:96–100.
54. Lifshitz Guinzberg A, Pomposo García-Cohen ASF. Las ciencias de la complejidad y la educación médica. Inv Ed Med. 2017;6(24):267-271.
55. Bell MM, Alaestante G, Finch C. A multidisciplinary approach to preventing catheter-associated urinary tract infections through education, care continuity, and system-wide support. 2016. Ochsner Journal 16:96–100.
56. Atkins L, Sallis A, Chadborn T, Shaw K, Schneider A, Hopkins S, Bunten A, Michie S, Lorencatto F. Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioural analysis of interventions. Implement Sci. 2020 Jul 6;15(1):44. doi: 10.1186/s13012-020-01001-2. PMID: 32624002; PMCID: PMC7336619.
57. Asociación Española de Urología. Posicionamiento basado en la evidencia sobre la Prevención de las Infecciones del Tracto Urinario (ITU) relacionadas con el uso del Sondaje Vesical (SV).2020. Available at: https://www.aeu.es/UserFiles/files/PosicionamientoAEUPrevencionITU-SV.pdf
58. Tenutto M, Sabelli, MJ. Evaluación de desempeño: evaluación por estaciones. In Ferreyra, Horacio y Tenutto, Marta (comp.) Planificar, enseñar, aprender y evaluar en educación superior. 202.Novedades Educativas. ISBN 978-987-538-792-8.
59. Rosenthal VD, Memish ZA, Nicastri E, Leone S, Bearman G. Preventing catheter-associated urinary tract infections: A position paper of the International Society for Infectious Diseases, 2024 update. Int J Infect Dis. 2025 Feb;151:107304. doi: 10.1016/j.ijid.2024.107304. Epub 2024 Nov 17. PMID: 39551089.
2. Saint S, Trautner BW, Fowler KE, Colozzi J, Ratz D, Lescinskas E, Hollingsworth JM, Krein SL. A Multicenter Study of Patient-Reported Infectious and Noninfectious Complications Associated With Indwelling Urethral Catheters. JAMA Intern Med. 2018 Aug 1;178(8):1078-1085
3. Saint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control. 2000 Feb;28(1):68-75.
4. Grand View Research. Medical Devices. Urinary Catheters Market Size. Share & Trends Report, 2030. Report ID: GVR-1-68038-381-2. Available at: https://www.grandviewresearch.com/industry-analysis/urinary-catheters-market
5. Klevens RM, Edwards JR, Richards CL,Jr, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122(2):160-166.
6. Centers for Disease Control and Prevention. Guideline for prevention of catheter-associated urinary tract infections (2009). January 2025. Available at: https://www.cdc.gov/infection-control/hcp/cauti/background.html?CDC_AAref_Val=https://www.cdc.gov/infectioncontrol/guidelines/cauti/background.html
7. European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines. Kranz, Jennifer et al. European Urology, Volume 86, Issue 1, 27 – 41.
8. Rosenthal VD, Memish ZA, Nicastri E, Leone S, Bearman G. Preventing catheter-associated urinary tract infections: A position paper of the International Society for Infectious Diseases, 2024 update. Int J Infect Dis. 2025 Feb;151:107304.
9. Stone PW. Economic burden of healthcare-associated infections: an American perspective. Expert Rev Pharmacoecon Outcomes Res 2009; 9 :417–22. doi: 10. 1586/erp.09.53.
10. Patel PK, Advani SD, Kofman AD, et al. Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology. 2023;44(8):1209-1231.
11. National Institute for Health and Care Excellence (NICE). Infection prevention and control. QS61. April 2014. Available at: https://www.nice.org.uk/guidance/qs61
12. Reid, S., Brocksom, J., Hamid, R., Ali, A., Thiruchelvam, N., Sahai, A., Harding, C., Biers, S., Belal, M., Barrett, R., Taylor, J. and Parkinson, R. (2021), British Association of Urological Surgeons (BAUS) and Nurses (BAUN) consensus document: management of the complications of long-term indwelling catheters. BJU Int, 128: 667-677.
13. Kranz J, Bartoletti R, Bruyère F, Cai T, Geerlings S, Köves B, Schubert S, Pilatz A, Veeratterapillay R, Wagenlehner FME, Bausch K, Devlies W, Horváth J, Leitner L, Mantica G, Mezei T, Smith EJ, Bonkat G. European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines. Eur Urol. 2024 Jul;86(1):27-41.
14. The European Association of Urology Nurses (EAUN). V. Geng (Chair), H. Lurvink, I. Pearce, S. Vahr Lauridsen. Guideline Indwelling catheterisation in adults – Urethral and suprapubic. 2024 (online) Available at: https://nurses.uroweb.org/guideline/indwelling-catheterisation-in-adults-urethral-and-suprapubic/
15. Amorone Leiva JL, María Agüero D, Caballero González C, Cecilia Postiglione M. Necrosis total de pene por cuidado inapropiado del colector urinario externo [Total penile necrosis due to inappropriate care of condom catheter]. Rev Esp Geriatr Gerontol. 2019 Jan-Feb;54(1):57-58.
16. Amorone Leiva JL, Puscinski AJ. Recomendaciones para el tratamiento de LUTS por HPB. 2012.Rev. Arg. de Urol. Vol. 77 (Suplemento 1).
17. Puscinski AJ, Amorone JL. Implante de Prótesis y Biomateriales en Urología. 2013. ISBN 9789872731991. NLM ID: 101660531.
18. Werneburg GT. Catheter-Associated Urinary Tract Infections: Current Challenges and Future Prospects. Res Rep Urol. 2022 Apr 4;14:109-133.
19. Chant C, Smith OM, Marshall JC, Friedrich JO. Relationship of catheter-associated urinary tract infection to mortality and length of stay in critically ill patients: a systematic review and meta-analysis of observational studies. Crit Care Med. Number2011;39(5):1167–1173.
20. Peng D, Li X, Liu P, et al. Epidemiology of pathogens and antimicrobial resistance of catheter-associated urinary tract infections in intensive care units: a systematic review and meta-analysis. Am J Infect Control. 2018;46(12):e81–e90.
21. Stevenson KB, Moore J, Colwell H, Sleeper B. Standardized infection surveillance in long-term care interfacility comparisons from a regional cohort of facilities. Infect Cont Hosp Epidemiol. 2005;26(3):231–238.
22. Rinke ML, Oyeku SO, Heo M, Saiman L, Zachariah P, Rosenberg RE, DeLaMora P, Rabin B, Mirhaji P, Klein E, Ford WJH, Obaro-Best O, Drasher M, Peshansky A, Balem KA, Bundy DG. Pediatric ambulatory catheter-associated urinary tract infections (CAUTIs): Incidence, risk factors, and patient outcomes. Infect Control Hosp Epidemiol. 2020 Aug;41(8):891-899.
23. Tandogdu Z, Wagenlehner FM. Global epidemiology of urinary tract Infections. Curr Opin Infect Dis. 2016;29(1):73–9.
24. Zilberberg MD, Nathanson BH, Sulham K, Shorr AF. Descriptive epidemiology and outcomes of hospitalizations with complicated urinary tract Infections in the United States, 2018. Open Forum Infect Dis. 2022;9(1):ofab591.
25. Redder JD, Leth RA, Moller JK. Analysing risk factors for urinary tract Infection based on automated monitoring of hospital-acquired Infection. J Hosp Infect. 2016;92(4):397–400.
26. Detweiler K, Mayers D, Fletcher SG. Bacteruria and urinary tract Infections in the Elderly. Urol Clin North Am. 2015;42(4):561–8.
27. Shen L, Fu T, Huang L, Sun H, Wang Y, Sun L, Lu X, Zhang J, Yang Z, Ni C. 7295 elderly hospitalized patients with catheter-associated urinary tract infection: a case-control study. BMC Infect Dis. 2023 Nov 24;23(1):825.
28. Mack WN, Mack JP, Ackerson AO. Microbial film development in a trickling filter. 1975, Volume 2, Issue 3, pp 215–226.
29. Costerton, J.W.; Geesey, G.G.; Cheng, K.J. How bacteria stick. Sci. Am. 1978, 238, 86–95.
30. Costerton, J.W.; Stewart, P.S.; Greenberg, E.P. Bacterial biofilms: A common cause of persistent infections. Science 1999, 284, 1318–1322.
31. Center for Biofilm Engineering. Biofilm Basics. Brief history of biofilm. Available at: https://biofilm.montana.edu/biofilm-basics/brief-history-biofilm.html
32. Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev. 2002 Apr;15(2):167-93. doi: 10.1128/CMR.15.2.167-193.2002.
33. Bouhrour N, Nibbering PH, Bendali F. Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens. Pathogens. 2024 May 8;13(5):393.
34. EClinicalMedicine. Antimicrobial resistance: a top ten global public health threat. EClinicalMedicine. 2021 Nov 24;41:101221.
35. Yuan L, Straub H, Shishaeva L, Ren Q. Microfluidics for Biofilm Studies. Annu Rev Anal Chem (Palo Alto Calif). 2023 Jun 14;16(1):139-159.
36. Clarke OE, Bennett V, Jones BV. An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection. J Vis Exp. 2025 Jun 24;(220).
37. Muraveva, V., Lomadze, N., Gordievskaya, Y.D. et al. Manipulation of artificial and living small objects by light driven diffusioosmotic flow. Sci Rep 14, 18342 (2024). https://doi.org/10.1038/s41598-024-69001-6
38. Stewart E, Hochstedler-Kramer BR, Khemmani M, Clark NM, Parada JP, Farooq A, Doshi C, Wolfe AJ, Albarillo FS. Characterizing the urobiome in geriatric males with chronic indwelling urinary catheters: an exploratory longitudinal study. Microbiol Spectr. 2024 Nov 5;12(11):e0094124.
39. Francolini I, Vuotto C, Piozzi A, Donelli G. Antifouling and antimicrobial biomaterials: an overview. APMIS. 2017 Apr;125(4):392-417.
40. Li C, Gao D, Li C, Cheng G, Zhang L. Fighting against biofilm: The antifouling and antimicrobial material. Biointerphases. 2024 Jul 1;19(4):040802.
41. Zhang Q, Zong Q, Feng X, Luo M, Sun W, Zhai Y. Antibacterial and antifouling materials for urinary catheter coatings. Acta Biomater. 2025 Jan 15;192:28-47.
42. Andersen MJ, Flores-Mireles AL. Urinary Catheter Coating Modifications: The Race against Catheter-Associated Infections. Coatings. 2020; 10(1):23.
43. Sharma S, Mohler J, Mahajan SD, Schwartz SA, Bruggemann L, Aalinkeel R. Microbial Biofilm: A Review on Formation, Infection, Antibiotic Resistance, Control Measures, and Innovative Treatment. Microorganisms. 2023 Jun 19;11(6):1614. doi: 10.3390/microorganisms11061614. Erratum in: Microorganisms. 2024 Sep 27;12(10):1961.
44. Wang L, Zhang S, Keatch R, Corner G, Nabi G, Murdoch S, Davidson F, Zhao Q. In-vitro antibacterial and anti-encrustation performance of silver-polytetrafluoroethylene nanocomposite coated urinary catheters. J Hosp Infect. 2019 Sep;103(1):55-63.
45. Arunachalam KD, Annamalai SK, Hari S. One-step green synthesis and characterization of leaf extract-mediated biocompatible silver and gold nanoparticles from Memecylon umbellatum. Int J Nanomedicine. 2013;8:1307-15.
46. Malka E, Perelshtein I, Lipovsky A, Shalom Y, Naparstek L, Perkas N, Patick T, Lubart R, Nitzan Y, Banin E, Gedanken A. Eradication of multi-drug resistant bacteria by a novel Zn-doped CuO nanocomposite. Small. 2013 Dec 9;9(23):4069-76.
47. Folawewo AD, Bala MD. Nanocomposite Zinc Oxide-Based Photocatalysts: Recent Developments in Their Use for the Treatment of Dye-Polluted Wastewater. Water. 2022; 14(23):3899. https://doi.org/10.3390/w14233899
48. Yan P, Chen D, Muhammad S, Guo Y, Gao Q, Niu B, Liu Y, Liu C. Carboxymethyl chitosan-immobilized silver nanoparticles for intravesical instillation: A strategy to prevent catheter-associated urinary tract infections. Int J Biol Macromol. 2025 Jul 14;320(Pt 4):146001.
49. Mosayyebi A, Manes C, Carugo D, Somani BK. Advances in Ureteral Stent Design and Materials. Curr Urol Rep. 2018 Apr 10;19(5):35.
50. Diaz Blanco C, Ortner A, Dimitrov R, Navarro A, Mendoza E, Tzanov T. Building an antifouling zwitterionic coating on urinary catheters using an enzymatically triggered bottom-up approach. ACS Appl Mater Interfaces. 2014 Jul 23;6(14):11385-93.
51. Lipovsky A, Thallinger B, Perelshtein I, Ludwig R, Sygmund C, Nyanhongo G, et al. Ultrasound coating of polydimethylsiloxanes with antimicrobial enzymes. Journal of Materials Chemistry B. 2015;3(35):7014-9.
52. Snarr BD, Baker P, Bamford NC, Sato Y, Liu H, Lehoux M, Gravelat FN, Ostapska H, Baistrocchi SR, Cerone RP, Filler EE, Parsek MR, Filler SG, Howell PL, Sheppard DC. Microbial glycoside hydrolases as antibiofilm agents with cross-kingdom activity. Proc Natl Acad Sci U S A. 2017 Jul 3;114(27):7124-7129.
53. Bell MM, Alaestante G, Finch C. A multidisciplinary approach to preventing catheter-associated urinary tract infections through education, care continuity, and system-wide support. 2016. Ochsner Journal 16:96–100.
54. Lifshitz Guinzberg A, Pomposo García-Cohen ASF. Las ciencias de la complejidad y la educación médica. Inv Ed Med. 2017;6(24):267-271.
55. Bell MM, Alaestante G, Finch C. A multidisciplinary approach to preventing catheter-associated urinary tract infections through education, care continuity, and system-wide support. 2016. Ochsner Journal 16:96–100.
56. Atkins L, Sallis A, Chadborn T, Shaw K, Schneider A, Hopkins S, Bunten A, Michie S, Lorencatto F. Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioural analysis of interventions. Implement Sci. 2020 Jul 6;15(1):44. doi: 10.1186/s13012-020-01001-2. PMID: 32624002; PMCID: PMC7336619.
57. Asociación Española de Urología. Posicionamiento basado en la evidencia sobre la Prevención de las Infecciones del Tracto Urinario (ITU) relacionadas con el uso del Sondaje Vesical (SV).2020. Available at: https://www.aeu.es/UserFiles/files/PosicionamientoAEUPrevencionITU-SV.pdf
58. Tenutto M, Sabelli, MJ. Evaluación de desempeño: evaluación por estaciones. In Ferreyra, Horacio y Tenutto, Marta (comp.) Planificar, enseñar, aprender y evaluar en educación superior. 202.Novedades Educativas. ISBN 978-987-538-792-8.
59. Rosenthal VD, Memish ZA, Nicastri E, Leone S, Bearman G. Preventing catheter-associated urinary tract infections: A position paper of the International Society for Infectious Diseases, 2024 update. Int J Infect Dis. 2025 Feb;151:107304. doi: 10.1016/j.ijid.2024.107304. Epub 2024 Nov 17. PMID: 39551089.