In vitro Efficacy of Ureteral Catheters Impregnated with Ciprofloxacin, N-acetylcysteine and their Combinations on Microbial Adherence

Abstract

INTRODUCTION AND OBJECTIVES: To study the efficacies of urinary catheters impregnated with ciprofloxacin, N-acetylcysteine and their combinations in preventing the microbial adherence to their surfaces. METHODS: Eight different clinical bacterial species isolated from patients undergoing ureteral catheterization (Staphylococcus aureus, Coagulase negative staphylococci, Escherichia coli, Klebseilla pneumonie, Proteus vulgaris, Providencia rettgeri, Citrobacter freundii, Serratia marscens) were used in our study. The antimicrobial efficacies and durability of ureteral catheters coated through instant dip method with ciprofloxacin were determined using the modified Kirby-Bauer method. The efficacies of ureteral catheters impregnated with (0.5, 1 and 2 mg/ml) ciprofloxacin, (2, 4 and 8 mg/ml) N-acetylcysteine and CIP/NAC combinations (0.5/2, 1/4 and 2/8 mg/ml) on inhibiting microbial adherence to their surfaces were tested against 5 strains of each species. Segments coated with the tested agents were incubated with the tested microorganisms, washed, sonicated, cultured and the number of viable cells were determined. The inhibitory effect was determined by the reduction in the number of viable cells in comparison with controls. RESULTS: Ciprofloxacin coated ureteral catheters showed zones of inhibition ranged between 15 and 45 mm in diameter. Ciprofloxacin coated ureteral catheters were soaked in urine for 8 weeks and incubated at 37°C, maintained zones of inhibition ≥ 10 mm against the tested microorganisms for at least 3 weeks. Ciprofloxacin coated catheters (soaked in urine) still showed antimicrobial activities against the tested organisms and produce zones of inhibition that measured 2-10 mm at 8 weeks. It was found that the anti-adherent activity was concentration dependent. As catheters impregnated with 2 mg/ml ciprofloxacin and catheters impregnated with 8 mg/ml N-acetylcysteine showed a higher inhibitory effect for microbial adherence than the other tested ciprofloxacin and N-acetylcysteine concentrations (% of reduction of adherent viable cells was 85-99.97% and 83-99.97% of the controls). Catheters impregnated with CIP/NAC combination at a concentration of 2/8 mg/ml showed the highest inhibitory effect for microbial adherence (97-100% of the controls). CONCLUSIONS: Catheters impregnated with CIP/NAC combinations showed the highest efficacy and provided the highest protective effect against microbial adherence.