Use of triclosan-eluting ureteral stents in patients with long-term stents.
OBJECTIVE
Long-term use of ureteral stents is prevented by biofilm-related infection and encrustation mandating stent changes every few months. Triclosan is a broad-spectrum antimicrobial in numerous consumer and medical products and has been incorporated into a ureteral stent. We sought to determine the clinical effects of the triclosan-eluting stent in patients who needed long-term ureteral stenting.


METHODS
Eight patients with long-term stents were enrolled prospectively. All received a control stent for 3 months along with preoperative and postoperative antibiotics. After 3 months, the control stent was removed, and a triclosan-eluting stent was placed for 3 months with no antibiotics administered. For both indwelling periods, urine cultures were obtained weekly and biweekly for the first and last 6 weeks, respectively, and antibiotics were prescribed when patients had both a positive urine culture and symptoms of urinary tract infection. On removal, stents were assessed for microorganisms and encrustation.


RESULTS
Overall, similar microorganisms were isolated during each indwell period, although Staphylococcus and Enterococcus strains were isolated more frequently during control and triclosan stenting, respectively. Significantly fewer antibiotics were used during triclosan stenting, coinciding with a slightly higher number of positive urine cultures and significantly fewer symptomatic infections. No bacterial isolates developed antibiotic resistance during triclosan stent placement.


CONCLUSIONS
Antibiotic use with control stents resulted in bacterial antibiotic resistance, which was not the case with the triclosan-eluting stents. Although triclosan-eluting stents did not show a clinical benefit in terms of urine and stent cultures or overall subject symptoms compared with controls, their use did result in decreased antibiotic usage and significantly fewer symptomatic infections. The triclosan-eluting stent alone is not sufficient to reduce device-associated infections in this difficult patient population.
Cadieux
Peter A
PA
Lawson Health Research Institute, London, Ontario, Canada.
Chew
Ben H
BH
Nott
Linda
L
Seney
Shannon
S
Elwood
Chelsea N
CN
Wignall
Geoffrey R
GR
Goneau
Lee W
LW
Denstedt
John D
JD
D000891:Anti-Infective Agents, Local / Q000494:pharmacology* / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification / Q000648:ultrastructure; D018441:Biofilms / Q000187:drug effects / Q000254:growth & development; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000382:microbiology; D002408:Catheters, Indwelling / Q000382:microbiology; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D054855:Drug-Eluting Stents / Q000382:microbiology*; D006801:Humans; D008855:Microscopy, Electron, Scanning; D013997:Time Factors; D014260:Triclosan / Q000494:pharmacology* / Q000627:therapeutic use*; D014513:Ureter / Q000187:drug effects* / Q000382:microbiology; D014556:Urine / Q000382:microbiology
D000891:Anti-Infective Agents, Local; D014260:Triclosan