Bacteriophage can prevent encrustation and blockage of urinary catheters by Proteus mirabilis

Jonathan Nzakizwanayo, Aurélie Hanin, Diana R. Alves, Benjamin McCutcheon, Cinzia Dedi, Jonathan Salvage, Karen Knox, Bruce Stewart, Anthony Metcalfe, Jason Clark, Brendan F. Gilmore, Cormac G M Gahan, A. Toby A Jenkins, Brian V. Jones

Research output: Contribution to journalArticlepeer-review

50 Citations (SciVal)


Proteus mirabilis forms dense crystalline biofilms on catheter surfaces that occlude urine flow, leading to serious clinical complications in long-term catheterized patients, but there are presently no truly effective approaches to control catheter blockage by this organism. This study evaluated the potential for bacteriophage therapy to control P. mirabilis infection and prevent catheter blockage. Representative in vitro models of the catheterized urinary tract, simulating a complete closed drainage system as used in clinical practice, were employed to evaluate the performance of phage therapy in preventing blockage. Models mimicking either an established infection or early colonization of the catheterized urinary tract were treated with a single dose of a 3-phage cocktail, and the impact on time taken for catheters to block, as well as levels of crystalline biofilm formation, was measured. In models of established infection, phage treatment significantly increased time taken for catheters to block (∼ 3-fold) compared to untreated controls. However, in models simulating early-stage infection, phage treatment eradicated P. mirabilis and prevented blockage entirely. Analysis of catheters from models of established infection 10 h after phage application demonstrated that phage significantly reduced crystalline biofilm formation but did not significantly reduce the level of planktonic cells in the residual bladder urine. Taken together, these results show that bacteriophage constitute a promising strategy for the prevention of catheter blockage but that methods to deliver phage in sufficient numbers and within a key therapeutic window (early infection) will also be important to the successful application of phage to this problem.

Original languageEnglish
Pages (from-to)1530-1536
Number of pages7
JournalAntimicrobial Agents and Chemotherapy
Issue number3
Early online date28 Dec 2015
Publication statusPublished - 1 Mar 2016


  • Bacteriophages/isolation & purification
  • Biofilms/growth & development
  • Catheters, Indwelling/microbiology
  • Drainage
  • Humans
  • Microscopy, Electron, Transmission
  • Models, Biological
  • Phage Therapy/methods
  • Proteus Infections/therapy
  • Proteus mirabilis/virology
  • Urinary Catheterization/adverse effects
  • Urinary Catheters/microbiology


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