Significance of Asymptomatic Bacteriuria in Spinal Cord Injury Patients on Condom Catheter

Sotolongo, Jose R.; Koleilat, Nadim

doi:10.1016/s0022-5347(17)40157-1

Cited by 29 publications

(12 citation statements)

References 8 publications

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“…Strain 83972 was originally isolated from a young Swedish girl with ABU who had carried it for at least 3 years without symptoms (2, 37). It is well adapted for growth in the urinary tract (UT), where it establishes long-term bacteriuria (2,23,75).A number of studies have compared the outcomes of treated versus untreated cases of ABU (20,36,66). These studies concluded that not only do patients with ABU not profit from antibiotic treatment, but also, if left untreated, they actually have a reduced risk of kidney infection.…”

mentioning

confidence: 99%

Mellowing Out: Adaptation to Commensalism by Escherichia coli Asymptomatic Bacteriuria Strain 83972

2007

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Mucosal surfaces in the intestinal, respiratory, and urogenital tracts are populated by a highly diverse bacterial flora. Most host-dwelling bacteria are commensals and maintain a symbiotic relationship with the host; however, a minority are pathogens that attack the mucosa, causing tissue damage and disease symptoms. Bacterial pathogens differ from commensals by the expression of specific virulence factors, such as those that mediate tissue assault. Commensals, in contrast, have generally been regarded as bacteria lacking such virulence factors or other specific mechanisms for interaction with host tissues. Asymptomatic carriage of bacteria may also result after a primary symptomatic infection. However, this type of carrier state differs from commensalism in that variants of pathogenic strains persist without evoking a host response. This review is focused on the molecular basis for attenuation of virulence and adaptation to commensalism, using the prototypic asymptomatic bacteriuria strain Escherichia coli 83972 as a model.Most E. coli strains coexist peacefully with their human host, while others cause disease. E. coli is a versatile pathogen causing a spectrum of diseases, including urinary tract infections (UTIs), diarrhea, sepsis, and meningitis (28). UTIs are among the most common infectious diseases of humans and are a major cause of morbidity. It is estimated that 40 to 50% of healthy adult women have experienced at least one UTI episode (15). Acute pyelonephritis and asymptomatic bacteriuria (ABU) represent the two extremes of UTI. Escherichia coli is responsible for Ͼ80% of UTIs. Acute pyelonephritis is a severe acute systemic infection caused by uropathogenic E. coli (UPEC) clones with virulence genes clustered on "pathogenicity islands" (13,16,25,46,67,72). ABU, on the other hand, is an asymptomatic carrier state that resembles commensalism. Paradoxically, a large proportion of UTIs are caused by ABU E. coli. Individuals infected with ABU group E. coli may carry high urine titers of a single E. coli strain for months or years without provoking a host response. According to conventional notions, pathogens can develop from commensals by the acquisition of virulence-associated genes located on, for example, pathogenicity islands or plasmids. The flip side of this evolutionary force is the equally important adaptation of the newly minted pathogen to its new host niche, where genes are inactivated by either point mutation, insertion, or deletion (39).Here we illustrate such an example, where the commensal-topathogen shift in E. coli is bidirectional. STRAIN 83972 AS A PROPHYLACTIC AGENTE. coli 83972 is a prototype ABU strain and is probably the best-characterized ABU-type E. coli strain to date. It is a clinical isolate capable of long-term bladder colonization. The strain lacks defined O and K surface antigens and is nonmotile (2). Also, electron microscopy of 83972 did not reveal the presence of flagella or a capsule (30, 56). Strain 83972 was originally isolated from a young Swedish girl with ABU who ...

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Mellowing Out: Adaptation to Commensalism by Escherichia coli Asymptomatic Bacteriuria Strain 83972

2007

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“…15 It would appear that the current antibiotic regimens only alter the symptomatology in some patients, but do not eradicate infecting organisms. If, as has been suggested,2 treatment is to commence without awaiting culture results, highly po tent agents, such as the fluoroquinolones, should be considered for 3-7 days duration.…”

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confidence: 99%

Bacterial biofilm formation on the bladder epithelium of spinal cord injured patients. II. Toxic outcome on cell viability

et al. 1993

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As a follow up to our first study of 10 spinal cord injured patients, a further 8 patients were investigated over 2 months for biofilm formation on their bladder epithelial cells and for evidence that these uropathogens damage the host bladder. All the patients were found to be colonized with uropathogens, regardless of whether or not they were receiving antibiotics. Using vital staining, it was discovered that there was a significant reduction (33%) in bladder cell viability in the presence of bacterial biofilms compared to controls. This was not associated with cell turnover rates. In vitro tests showed a similar reduction in cell viability when uropathogens were incubated with bladder cells. In addition, white cell counts were significantly elevated in the patients' urine, indicative of an infectious and/or inflamed state. There was no difference between sympto matic and asymptomatic patients in their mean bacterial adhesion counts. Patients were just as likely to be symptomatic as asymptomatic when on antibiotics. In summary, the presence of virulent organisms in the bladder does adversely affect the host, even when the patient has insignificant signs and symptoms of infection, thereby raising concerns over the decision not to treat the patient. Unless specific antibiotics are used which eradicate adherent biofilms from the bladder, the treatment of symptomatic patients will only impact upon the signs and symptoms in some patients, and not alter their susceptibility to reinfection.

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“…The neurologic bladder dysfunction is the key event in the development of asymptomatic bacteriuria in this patient population (Erickson et al, 1982, Sanderson &Weissler, 1990, Schlager et al, 1995, Sotolongo &Koleilat, 1990. The prevalence of asymptomatic bacteriuria remains high independently of the method of bladder emptying (see Table 6-need ref).…”

Section: Patients With Spinal Cord-injuriesmentioning

confidence: 99%

“…However, symptomatic urinary tract infections are still a significant issue (DeVivo et al, 1985, Ditunno &Formal, 1994. Clinical studies, including prospective cohort studies and placebo-controlled trials show no decrease in symptomatic infection with antibiotic therapy for asymptomatic bacteriuria (Mohler et al, 1987) and no progression to renal failure with asymptomatic bacteriuria were observed, as long as a low urinary bladder pressure was maintained (Sotolongo &Koleilat, 1990). Therefore, screening for or treatment of asymptomatic bacteriuria in spinal cord injury populations is currently not recommended (Cardenas &Hooton, 1995, Ditunno &Formal, 1994.…”

Section: Patients With Spinal Cord-injuriesmentioning

confidence: 99%

Asymptomatic Bacteriuria: Significance for Different Patient Population

Nelius¹,

Filleur²,

Nelson³

2011

Urinary Tract Infections

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Significance of Asymptomatic Bacteriuria in Spinal Cord Injury Patients on Condom Catheter

Cited by 29 publications

References 8 publications

Mellowing Out: Adaptation to Commensalism by Escherichia coli Asymptomatic Bacteriuria Strain 83972

Mellowing Out: Adaptation to Commensalism by Escherichia coli Asymptomatic Bacteriuria Strain 83972

Bacterial biofilm formation on the bladder epithelium of spinal cord injured patients. II. Toxic outcome on cell viability

Asymptomatic Bacteriuria: Significance for Different Patient Population

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