title: Swarming of Proteus mirabilis over ureteral stents: a comparative assessment.
abstract: OBJECTIVE
  Encrustation on indwelling ureteral stents is commonly related to the presence of urease-producing bacteria that elevate the pH of the urine through the hydrolysis of urea, resulting in the precipitation of calcium and magnesium salts. Using a model previously shown to measure accurately the ability of Proteus mirabilis to swarm over catheter surfaces (Eur J Clin Microbiol Infect Dis 1999;18:206), we investigated the ability of this organism to swarm over three ureteral stents with potential encrustation-resistance properties.
  
  
  METHODS
  Three commercially available ureteral stents were selected for evaluation: a low surface-energy stent, a hydrogel-coated stent, and a silicone stent. Ten-microliter aliquots of a 4-hour culture of P. mirabilis 296 in Trypticase soya (TSA) broth was inoculated 5 mm from a 1-cm channel cut out from TSA plates. Ten-millimeter stent sections were placed as bridges across the central channel adjacent to the inocula. Time to pathogen crossing was measured.
  
  
  RESULTS
  The mean time (+/- SD) to pathogen migration across the three test materials was 15.9 +/- 6.1, 19.8 +/- 9.5, and 29.7 +/- 14.3 hours for the low surface-energy, hydrogel-coated, and silicone stents, respectively. Statistical analysis revealed significant differences between the crossing times of the low surface-energy (P = 0.001) and hydrogel-coated (P = 0.034) stents compared with silicone but not between the low surface-energy and hydrogel-coated stents (P = 0.387).
  
  
  CONCLUSIONS
  Migration of P. mirabilis 296 across silicone stents was significantly reduced compared with low surface-energy and hydrogel-coated stents. These findings suggest that P. mirabilis may have a lower affinity for silicone stents, which may translate into a reduced risk of infection with P. mirabilis and associated stent encrustation.
authors.affiliation: Division of Urology, University of Western Ontario, London, Ontario, Canada.
authors.forename: James D
authors.initials: JD
authors.lastname: Watterson
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cadieux
authors.forename: David
authors.initials: D
authors.lastname: Stickler
authors.forename: Gregor
authors.initials: G
authors.lastname: Reid
authors.forename: John D
authors.initials: JD
authors.lastname: Denstedt
mesh_terms: D004866:Equipment Contamination; D006801:Humans; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D066298:In Vitro Techniques; D008855:Microscopy, Electron, Scanning; D011512:Proteus Infections / Q000382:microbiology*; D011513:Proteus mirabilis / Q000502:physiology* / Q000648:ultrastructure; D015607:Stents / Q000382:microbiology*; D014513:Ureter; D014552:Urinary Tract Infections / Q000382:microbiology
chemical_list: D020136:Hydrogel, Polyethylene Glycol Dimethacrylate