Effect of triclosan on the formation of crystalline biofilms by mixed communities of urinary tract pathogens on urinary catheters.

The crystalline bacterial biofilms that encrust Foley catheters compromise the care of many elderly and disabled patients. The aim of this study was to examine whether the biocide triclosan can prevent encrustation by the mixed flora of uropathogens that commonly infect patients undergoing long-term catheterization. Models of the catheterized bladder were inoculated with communities of organisms isolated from patients who were experiencing catheter blockage. The catheter retention balloons were inflated with water or triclosan (3 g triclosan l(-1) in 0.1 M sodium carbonate) and urine was supplied to the models for up to 7 days. The effect of triclosan was recorded on the viable cell populations, the pH of the residual urine and the times that catheters took to block. The extent of encrustation of the catheters was visualized by scanning electron microscopy. In models inoculated with communities containing Proteus mirabilis, triclosan prevented the rise in urinary pH that drives crystalline biofilm formation and catheter blockage. The biocide had no effect on populations of Enterococcus faecalis and Pseudomonas aeruginosa, but Proteus mirabilis, Escherichia coli and Klebsiella pneumoniae were eliminated from the residual urine and the catheters drained freely for the 7-day experimental period. In models inoculated with a mixed community containing Providencia rettgeri, catheters inflated with triclosan continued to block rapidly. Although K. pneumoniae and Proteus vulgaris were eliminated from the residual urine, there was no effect on the viability of Providencia rettgeri. The results indicate that the triclosan strategy should be limited to the treatment of patients who are infected with Proteus mirabilis.