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Incontinence-associated dermatitis by infected urine: biological mechanisms and prevention strategies

Research Project

Project/Area Number 19K24194
Research Category

Grant-in-Aid for Research Activity Start-up

Allocation TypeMulti-year Fund
Review Section 0908:Society medicine, nursing, and related fields
Research InstitutionThe University of Tokyo

Principal Investigator

KOUDOUNAS SOFOKLIS  東京大学, 大学院医学系研究科(医学部), 特任研究員 (70849968)

Project Period (FY) 2019-08-30 – 2022-03-31
Project Status Granted (Fiscal Year 2020)
Budget Amount *help
¥2,860,000 (Direct Cost: ¥2,200,000、Indirect Cost: ¥660,000)
Fiscal Year 2020: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
Fiscal Year 2019: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
KeywordsIAD / infected urine / urinary-incontinence / older patients / dermatitis / bacteria / rat
Outline of Research at the Start

IAD is a painful complication among elderly patients, leading to a reduced quality of life. Physiological urine does not lead to the development of IAD; however, infected urine is severely irritating and increases the risk of skin damage. How infected urine leads to the development of IAD has never been investigated. Therefore, this study aims to elucidate the histopathological/molecular mechanisms of IAD caused by infected urine in order to develop new nursing interventions for complete prevention of IAD and ultimately improve the patients’ quality of life.

Outline of Annual Research Achievements

Last year, my research focused on developing an animal model of incontinence-associated dermatitis (IAD) due to urinary infections. I spent more than 6 months examining different conditions for maceration, bacterial application, and length of exposure (6hrs, 24hrs, 3days) in order to identify the best conditions to reproduce the symptoms of IAD in clinical practice. I conducted in vivo experiments with Sprague-Dawley rats and common uropathogens were grown in synthetic human urine (s-urine) supplemented with nutrients for bacterial growth.

Remarkably, my results demonstrated that skin areas exposed to bacteria developed an IAD-like erythematous response after 3 days of exposure which persisted for up to 5 days. These findings highlighted that it is possible to reproduce the irritant response of IAD due to urinary infections in experimental rats. Further work is needed to establish this clinically relevant IAD model for patients with urinary incontinence to study IAD pathophysiology, underlying molecular mechanisms and guide preventive strategies.

Current Status of Research Progress
Current Status of Research Progress

4: Progress in research has been delayed.

Reason

Despite sufficient progress to identify the conditions for the novel IAD model, there was a significant delay due to the Covid-19 pandemic to investigate in depth the underlying mechanisms. This will be the main goal for this fiscal year.

Strategy for Future Research Activity

Considering that the best conditions for this new IAD model have been determined, in vivo animal experiments will be conducted to investigate the skin physiology and the underlying histopathological and molecular mechanisms. For example, to understand physiological mechanisms the integrity of the skin will be assessed by recording skin surface pH as this is a critical parameter in IAD development and has been reported in clinical studies. Skin appearance
and morphology will be assessed macroscopically and by microscopic anatomical methods, respectively. Histology and immunohistological analysis
will be performed to reveal the changes in skin tissue structure in response to urine and bacteria. Real-time PCR will also be performed to reveal gene expression in damaged skin and identify the molecular pathway alterations in IAD. Together, these methods will decipher the mechanisms following exposure to bacteria and urine.

Report

(2 results)
  • 2020 Research-status Report
  • 2019 Research-status Report

Research Products

(6 results)

All 2021 2020 2019 Other

All Journal Article (1 results) (of which Int'l Joint Research: 1 results,  Peer Reviewed: 1 results,  Open Access: 1 results) Presentation (2 results) Remarks (3 results)

  • [Journal Article] Does the presence of bacterial urinary infection contribute to the development of incontinence-associated dermatitis? A scoping review2021

    • Author(s)
      Sofoklis Koudounas, Yuko Mugita, Takeo Minematsu, Gojiro Nakagami, Carolina Weller, Hiromi Sanada
    • Journal Title

      Journal of Tissue Viability

      Volume: 30 Pages: 256-261

    • DOI

      10.1016/j.jtv.2021.01.008

    • Related Report
      2020 Research-status Report
    • Peer Reviewed / Open Access / Int'l Joint Research
  • [Presentation] Development of an in vitro model of urinary infections to study the mechanisms leading to incontinence-associated dermatitis in patients with urinary incontinence2020

    • Author(s)
      Sofoklis Koudounas, Takeo Minematsu, Gojiro Nakagami, Yuko Mugita, Sanai Tomida, Hiromi Sanada
    • Organizer
      8th conference of the Japanese Society for Nursing Science and Engineering
    • Related Report
      2020 Research-status Report
  • [Presentation] The effects of urine on bacterial growth and motility: Implications in the development of incontinence-associated dermatitis2019

    • Author(s)
      Sofoklis Koudounas, Yuko Mugita, Takeo Minematsu, Gojiro Nakagami, Sanai Tomida, Hiromi Sanada
    • Organizer
      49th Japanese Society for Wound Healing
    • Related Report
      2019 Research-status Report
  • [Remarks] Department of Skincare Science

    • URL

      http://skincarescience.m.u-tokyo.ac.jp

    • Related Report
      2020 Research-status Report
  • [Remarks] Global Nursing Research Center

    • URL

      http://gnrc.m.u-tokyo.ac.jp/

    • Related Report
      2020 Research-status Report
  • [Remarks] Global Nursing Research Center, Univ Tokyo

    • URL

      http://gnrc.m.u-tokyo.ac.jp/

    • Related Report
      2019 Research-status Report

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Published: 2019-09-03   Modified: 2021-12-27  

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