{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T02:33:19Z","timestamp":1792636399256,"version":"4.5.0"},"reference-count":66,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2014,7,14]],"date-time":"2014-07-14T00:00:00Z","timestamp":1405296000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2014,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    This review is largely based on a previous paper published in the journal\n                    <jats:italic>Spinal Cord<\/jats:italic>\n                    . The care of many patients undergoing long\u2010term bladder catheterization is complicated by encrustation and blockage of their\n                    <jats:styled-content style=\"fixed-case\">F<\/jats:styled-content>\n                    oley catheters. This problem stems from infection by urease\u2010producing bacteria, particularly\n                    <jats:italic>\n                      <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>\n                      roteus mirabilis\n                    <\/jats:italic>\n                    . These organisms colonize the catheter forming an extensive biofilm; they also generate ammonia from urea, thus elevating the\n                    <jats:styled-content style=\"fixed-case\">pH<\/jats:styled-content>\n                    of urine. As the\n                    <jats:styled-content style=\"fixed-case\">pH<\/jats:styled-content>\n                    rises, crystals of calcium and magnesium phosphates precipitate in the urine and in the catheter biofilm. The continued development of this crystalline biofilm blocks the flow of urine through the catheter. Urine then either leaks along the outside of the catheter and the patient becomes incontinent or is retained causing painful distension of the bladder and reflux of urine to the kidneys. The process of crystal deposition can also initiate stone formation. Most patients suffering from recurrent catheter encrustation develop bladder stones.\n                    <jats:italic>P.\u00a0mirabilis<\/jats:italic>\n                    establishes stable residence in these stones and is extremely difficult to eliminate from the catheterized urinary tract by antibiotic therapy. If blocked catheters are not identified and changed, serious symptomatic episodes of pyelonephritis, septicaemia and endotoxic shock can result. All types of Foley catheters including silver\u2010 or nitrofurazone\u2010coated devices are vulnerable to this problem. In this review, the ways in which biofilm formation on Foley catheters is initiated by\n                    <jats:italic>P.\u00a0mirabilis<\/jats:italic>\n                    will be described. The implications of understanding these mechanisms for the development of an encrustation\u2010resistant catheter will be discussed. Finally, the way forward for the prevention and control of this problem will be considered.\n                  <\/jats:p>","DOI":"10.1111\/joim.12220","type":"journal-article","created":{"date-parts":[[2014,3,17]],"date-time":"2014-03-17T12:25:31Z","timestamp":1395059131000},"page":"120-129","source":"Crossref","is-referenced-by-count":204,"title":["Clinical complications of urinary catheters caused by crystalline biofilms: something needs to be done"],"prefix":"10.1111","volume":"276","author":[{"given":"D. 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