Indwelling Urological Device Biofilm Composition and Characteristics in the Presence and Absence of Infection.

OBJECTIVE

To characterize microbial biofilms associated with different device types used in the urological field including ureteral stents, sacral neuromodulation (SNM) devices, penile prostheses, and artificial urinary sphincters (AUS).

MATERIALS AND METHODS

Data from 4 studies, each reporting biofilm composition of a particular device type, were pooled and included for inter-device analysis. Studies recruited adults scheduled for ureteral stent, SNM, IPP, or AUS removal/revision. Device (n = 115) biofilms and controls were analyzed with multi-omics approaches, and compositions were compared across device types and clinical factors.

RESULTS

Microbiota present on each device type was distinct from that of perineal, rectal, or urine flora (P <.01). Biofilm microbial counts (P <.001) and diversity (P = .024) differed by device type. Ureteral stents had greater microbial counts than other device types (P <.001). Staphylococcus, Pseudomonas, Lactobacillus, Ureaplasma were commonly detected across devices. Device biofilms harbored a greater proportion of Proteobacteria phylum, and the rectal, perineal, and urine flora harbored a greater proportion of Firmicutes. Unique microbe-metabolite interaction networks were identified in presence and absence of infection. Antibiotic-resistance genes including sul2 (sulfonamide resistance) and rpoB (rifampin resistance) were detected in biofilms across device types. Biofilm reconstitution in vitro differed by device type from which strains were isolated.

CONCLUSION

Ureteral stents, sacral neuromodulation devices, penile prostheses, and artificial urinary sphincters harbored unique microbial and metabolite profiles that differed from those of skin, urine, and rectal flora. The findings of this study set the groundwork for investigation of novel strategies to reduce device-associated infection risk within and outside urology.