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Unlabelled: What's known on the subject? and What does the study add? Infection, encrustation and ureteral-stent-related symptoms (USRS) including pain, urgency and frequency are all major problems associated with stent use. No current ureteral stent or exogenously applied therapy adequately deals with these problems and antibiotic use is ineffective once a bacterial biofilm forms on the device. Triclosan is a broad spectrum antibacterial agent widely used in numerous healthcare products and has been previously shown to reduce inflammation on the skin and in the oral cavity. This study tested a triclosan-impregnated ureteral stent for its ability to reduce infection, encrustation and USRS. This study shows that while a triclosan-impregnated ureteral stent cannot reduce infection rates alone compared with antibiotic use, the stent can reduce several USRS including pain during indwelling. This study suggests that the triclosan eluting stent may have a role in treating patients, perhaps in combination with standard antibiotic therapy., Objective: To evaluate the capacity of triclosan-loaded ureteral stents to reduce stent-associated bacterial attachment, biofilm formation and encrustation, thereby potentially reducing infection development and other device-related sequelae., Patients and Methods: Twenty subjects requiring short-term stenting (7-15 days) were randomized to receive either a Percuflex Plus(®) non-eluting stent (control) or a Triumph(®) triclosan eluting stent. Control-stented subjects received 3 days of levofloxacin prophylaxis (500 mg once daily) while Triumph(®)-stented subjects did not. All subjects were assessed for positive urine and stent cultures, stent biofilm development and encrustation. Following device removal, each subject completed an analogue-scale symptom assessment questionnaire., Results: Ureteral stenting was performed after nine ureteroscopic and one extracorporeal shock wave lithotripsy procedure in the control group and eight ureteroscopic and two shock wave lithotripsy procedures in the triclosan group. No significant differences were observed for culture, biofilm and encrustation between the two groups. Subjects in the triclosan group reported significant reductions in lower flank pain scores during activity (58.1% reduction, P = 0.017) and urination (42.6%, P = 0.041), abdominal pain during activity (42.1%, P = 0.042) and urethral pain during urination (31.7%, P = 0.049)., Conclusions: In this study, the use of the Triumph(®) triclosan eluting stent had no marked impact on biofilm formation, encrustation or infection development in short-term stented patients. The Triumph(®) device led to significant reductions in several common ureteral-stent-related symptoms, supporting its use in this patient population., (© 2012 BJU INTERNATIONAL.)

Background and Purpose: 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., Patients and 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.

Introduction: Triclosan is a broad-spectrum antimicrobial agent currently used in numerous products including surgical scrubs and ureteral stents. Unfortunately, studies have shown triclosan resistance among several bacterial species. Our objective was to characterize resistance patterns of common uropathogens to triclosan and determine whether triclosan exposure would alter their susceptibility to common antibiotics. We hypothesized that triclosan exposure induces a metabolic stress rendering some bacterial strains more susceptible to other antibiotics., Methods: Using largely clinical isolates comprising seven uropathogenic species, we conducted 24 hour growth experiments to determine triclosan minimal inhibitory concentrations (MIC) for each strain. Based upon these MICs, triclosan was added to agar plates at escalating sublethal concentrations and antibiotic disk diffusion assays were conducted using a range of clinically-relevant antibiotics., Results: Varying susceptibility patterns were observed across all antibiotics studied. Several antibiotics demonstrated increased efficacy in conjunction with triclosan. The combined effect of triclosan with amoxicillin and gentamicin was superior when considering significant increases in susceptibility, with 6 (86%) and 5 (71%) of the 7 bacterial strains displaying enhanced sensitivity, respectively. The antimicrobial effects of nitrofurantoin and the fluoroquinolones were significantly enhanced for 4 (57%), 4 and 3 (42%) of the 7 pathogens, respectively. The two fluoroquinolones were the only antibiotics where susceptibility was negatively impacted (in one strain each) in combination with triclosan., Conclusions: The synergistic effects of triclosan and several antibiotics are consistent with a triclosan-dependent metabolic strain and/or membrane disruptive effect, and offers important insight into the combined use of antimicrobial compounds in clinical practice.