title: Urinary catheter capable of repeated on-demand removal of infectious biofilms via active deformation.
abstract: Biofilm removal from biomaterials is of fundamental importance, and is especially relevant when considering the problematic and deleterious impact of biofilm infections on the inner surfaces of urinary catheters. Catheter-associated urinary tract infections are the most common cause of hospital-acquired infections and there are over 30 million Foley urinary catheters used annually in the USA. In this paper, we present the design and optimization of urinary catheter prototypes capable of on-demand removal of biofilms from the inner luminal surface of catheters. The urinary catheters utilize 4 intra-wall inflation lumens that are pressure-actuated to generate region-selective strains in the elastomeric urine lumen, and thereby remove overlying biofilms. A combination of finite-element modeling and prototype fabrication was used to optimize the catheter design to generate greater than 30% strain in the majority of the luminal surface when subjected to pressure. The catheter prototypes are able to remove greater than 80% of a mixed community biofilm of Proteus mirabilis and Escherichia coli on-demand, and furthermore are able to remove the biofilm repeatedly. Additionally, experiments with the prototypes demonstrate that biofilm debonding can be achieved upon application of both tensile and compressive strains in the inner surface of the catheter. The fouling-release catheter offers the potential for a non-biologic, non-antibiotic method to remove biofilms and thereby for impacting the thus far intractable problem of catheter-associated infections.
authors.affiliation: Research Triangle Materials Research Science and Engineering Center, Duke University, Durham, NC 27708, USA; Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.
authors.forename: Vrad
authors.initials: V
authors.lastname: Levering
authors.affiliation: Research Triangle Materials Research Science and Engineering Center, Duke University, Durham, NC 27708, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA.
authors.forename: Changyong
authors.initials: C
authors.lastname: Cao
authors.affiliation: Research Triangle Materials Research Science and Engineering Center, Duke University, Durham, NC 27708, USA; Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.
authors.forename: Phanindhar
authors.initials: P
authors.lastname: Shivapooja
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Levinson
authors.affiliation: Research Triangle Materials Research Science and Engineering Center, Duke University, Durham, NC 27708, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Boston, MA 02139, USA. Electronic address: zhaox@mit.edu.
authors.forename: Xuanhe
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Research Triangle Materials Research Science and Engineering Center, Duke University, Durham, NC 27708, USA; Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA. Electronic address: gabriel.lopez@duke.edu.
authors.forename: Gabriel P
authors.initials: GP
authors.lastname: López
mesh_terms: D001422:Bacterial Adhesion; D018441:Biofilms / Q000254:growth & development; D055499:Catheter-Related Infections / Q000517:prevention & control; D004866:Equipment Contamination; D004867:Equipment Design; D004926:Escherichia coli / Q000502:physiology; D020342:Finite Element Analysis; D006801:Humans; D008962:Models, Theoretical; D011312:Pressure; D011513:Proteus mirabilis / Q000502:physiology; D013314:Stress, Mechanical; D014546:Urinary Catheterization; D062885:Urinary Catheters; D014552:Urinary Tract Infections / Q000517:prevention & control
keywords: Biofilm removal; Deformation; Finite element model; Infection; Urinary catheter