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

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

65 Scopus citations


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

Bibliographical note

Funding Information:
This perspective review has been written as a part of the EU-funded Trans Domain COST Action, TD 1305 iPROMEDAI (improved protection of medical devices against infection), in the focus group for urinary tract devices. The aim of the work performed in this group has been to bridge different areas of expertise, discuss and give suggestions for ways in which testing of medical devices aimed at preventing infection should be performed to follow best practices, as well as to enhance the predictability of methods for clinical outcome of a device with respect to infection. The authors would like to acknowledge COST (European Cooperation in Science and Technology) for funding of the network, as well as network participants that have given input in discussions forming the base for this paper, including Dr. Cesar Rodrigues-Emmenegger, Prof. Erik Reimhult, Prof. Peter Tenke, Dr. Botond Lakatos, Dr. Naseem Theilgaard, Dr. Reto Luginbuehl, Prof. Yannis Missirlis, Dr. Matthias Buhmann, Dr. Vesna Miskovic-Stankovic, Dr. Veronique Fontaine, Dr. Jose-Ramon Sarasua. Project PTDC/BTM-SAL/29335/2017, Portuguese Government, Fundação para a Ciência e Tecnologia (FCT), and designer Nuno Monge is acknowledged for assistance with the artworks of Figures, and.

Publisher Copyright:
© 2019 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim


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


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