Evaluating Efficacy of Antimicrobial and Antifouling Materials for Urinary Tract Medical Devices: Challenges and Recommendations

Madeleine Ramstedt, Isabel A.C. Ribeiro, Helena Bujdakova, Filipe J.M. Mergulhão, Luisa Jordao, Peter Thomsen, Martin Alm, Mette Burmølle, Todorka Vladkova, Fusun Can, Meital Reches, Martijn Riool, Alexandre Barros, Rui L. Reis, Emilio Meaurio, Judith Kikhney, Annette Moter, Sebastian A.J. Zaat, Jelmer Sjollema

Research output: Contribution to journalReview articlepeer-review


In Europe, the mean incidence of urinary tract infections in intensive care units is 1.1 per 1000 patient-days. Of these cases, catheter-associated urinary tract infections (CAUTI) account for 98%. In total, CAUTI in hospitals is estimated to give additional health-care costs of £1–2.5 billion in the United Kingdom alone. This is in sharp contrast to the low cost of urinary catheters and emphasizes the need for innovative products that reduce the incidence rate of CAUTI. Ureteral stents and other urinary-tract devices suffer similar problems. Antimicrobial strategies are being developed, however, the evaluation of their efficacy is very challenging. This review aims to provide considerations and recommendations covering all relevant aspects of antimicrobial material testing, including surface characterization, biocompatibility, cytotoxicity, in vitro and in vivo tests, microbial strain selection, and hydrodynamic conditions, all in the perspective of complying to the complex pathology of device-associated urinary tract infection. The recommendations should be on the basis of standard assays to be developed which would enable comparisons of results obtained in different research labs both in industry and in academia, as well as provide industry and academia with tools to assess the antimicrobial properties for urinary tract devices in a reliable way.

Original languageAmerican English
Article number1800384
JournalMacromolecular Bioscience
Issue number5
StatePublished - May 2019


  • antimicrobial
  • device-associated urinary tract infections
  • in vitro
  • in vivo
  • material testing

All Science Journal Classification (ASJC) codes

  • Bioengineering
  • Materials Chemistry
  • Polymers and Plastics
  • Biotechnology
  • Biomaterials


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