The Development and Effect of Bacterial

Biofilm on Urethral Catheters

What are urethral catheters? Why are urethral catheters needed? What risks arise from having a
urethral catheter for elongated periods? Urethral catheters are medical devices commonly used in
nursing homes and hospitals to treat illnesses like urinary retention and incontinence and chronic
conditions like spinal cord injuries. Urethral catheters are inserted into the urethra to drain urine from
the bladder.

Long-term catheterisation is when the urethral catheter is left in the body for more than 28 days, while
under general conditions, a catheter is not meant to be left in the body as this increases the risk of
infection; there are some cases, such as for patients who may have a neurogenic bladder, where it is
deemed necessary. Long-term catheterisation is mainly used in community care for elderly patients,
where it manages urinary incontinence and minimises pressure ulcers. However, long-term
catheterisation means the care of these patients is compromised, as infections and biofilms are more
likely to form on the catheter’s surface.

Urinary catheters are becoming increasingly common, and hundreds of thousands benefit from them;
however, it compromises the built-in defences our body’s urinary tract has. In recent years, infection
in biofilms developing on long-term urethral catheters has become much more common. It is a
growing concern in healthcare – costing the NHS many billions of pounds as well as being the cause
of up to 2100 deaths.

Bacterial Biofilm Development

Suppose aseptic handling procedures are not followed when fitting catheters, microorganisms from
the skin around the urethral hole may enter the tract transferring themselves onto the catheter and
bladder. In addition, the catheter’s design and placement of the inflation balloon cause urine to pool in
the bladder, which is constantly filled with nutrients from the kidney, providing the bacteria with an
optimal habitat for it to flourish.

Biofilm is a community of microorganisms like bacteria or fungi that build intricate structures on
surfaces. The bacteria are encased in a self-produced matrix consisting of EPS (extracellular
polymeric substances), which protect them from external threats like antibiotics or a body’s immune
response. Bacterial cells are believed to exist in biofilm communities, as it is easier to deal with
environmental stress this way.

Biofilm occurs naturally in the human body, not just due to medical devices; however, biofilm
formation in the form of dental plaque proposes less risk compared to bacterial biofilm formation on
medical devices dwelling inside your body, as this can lead to the device failure as well as being
resistant to antibiotics, resisting treatment and being difficult to eliminate.

CAUTIs – (Catheter-Associated Urinary Tract Infections)

Bacterial biofilms can form quickly on catheters, as the surface striations around the hole facilitate the
adhesion of bacterial cells – forming the layers to further their development; catheters have a constant
supply of nutrients from the kidney. Bacteria can multiply and grow exponentially with the rich
nutrient supply and protective biofilm. They can leave the localised catheter infection site and move
into the bloodstream, causing other more severe illnesses like sepsis. In addition, biofilms make
bacteria more resistant to bacteria as the EPS matrix that protects it prevents antibiotics from entering
and treating the bacteria.

Bacteria such as the Proteus mirabilis can build crystalline biofilms, the most common reason for
clinical complications. Crystalline biofilms and blockages can occur rapidly, leading to urine leakage
or an accumulation of infected urine in the bladder.

In conclusion, bacterial biofilms continue to be a significant issue in treatment, with patients

susceptible to both biofilm-related infections and the development of crystalline biofilms, which may
escalate and lead to stones. This has and continues to result in emergency hospital referrals and care.

While progress has been made by researchers in both the scientific and healthcare communities, there
is still much more research to be done to understand the scope of this issue and to reduce the financial
and human cost of diseases caused by urethral catheters, especially because catheterisation is needed
to prolong the lives of such patients – hence a solution needed as researchers have said it is achievable
but will require interdisciplinary effort and engagement from the scientific community.