Surgical procedures often create the need for using urinary catheters. However, a significant challenge associated with these catheters is the difficulty in predicting who might develop catheter-associated urinary tract infections (CAUTIs), which can potentially be fatal. Now, a study has identified a specific population more vulnerable to CAUTIs, paving the way for the development of a new catheter designed to reduce the inflammation and mechanical damage typically caused by conventional catheters.

The study conducted by researchers at the University of Notre Dame (Notre Dame, IN, USA) revealed that models with fibrinolytic deficiencies—conditions that result in the overactivation of the protein fibrin—are at a higher risk for severe and persistent CAUTIs. These models were also found to be more prone to developing sepsis. Fibrin plays a crucial role in blood clot formation, which is vital for the body’s repair mechanism following injuries. During the healing process, fibrinogen is converted into fibrin, forming net-like structures that accumulate and provide a breeding ground for pathogens, thereby fostering persistent infections. In their study of how this healing process could inadvertently facilitate infections during urinary catheterization using animal models, the researchers discovered that an increase in fibrin nets made the models more susceptible to high levels of pathogen colonization and elevated fibrinogen in the bloodstream. Consequently, the more fibrin present in the blood, the greater the likelihood of a CAUTI spreading to other organs.

However, blocking fibrinogen recruitment or accumulation significantly reduced CAUTIs, as the pathogens rely on the fibrin net-like structures for survival and proliferation. The study also noted that antifibrinolytic medications, commonly used in managing postpartum hemorrhages, traumatic injuries, and during surgical interventions, might increase the risk of CAUTIs in patients with catheters. Given the existing uncertainties on the best approaches for treating CAUTIs, the findings from this study provide valuable insights into prevention and management strategies. The innovative catheter developed by the researchers aims to mitigate CAUTIs by minimizing the inflammation and mechanical damage that traditional catheters cause and by preventing the formation of fibrin structures that enable pathogen infections.

“We strongly believe these findings provide key data to inform urinary catheterization guidelines in health care facilities and intensive care units, which will provide a higher quality of life to patients and minimize risk for complications,” said Ana Lidia Flores-Mireles, the Hawk Assistant Professor of Biological Sciences at Notre Dame. 

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