Bladder catheterization increases susceptibility to infection that can be prevented by prophylactic antibiotic treatment
Matthieu Rousseau, … , Molly A. Ingersoll, Kimberly A. Kline
Matthieu Rousseau, … , Molly A. Ingersoll, Kimberly A. Kline
Published September 22, 2016
Citation Information: JCI Insight. 2016;1(15):e88178. https://doi.org/10.1172/jci.insight.88178.
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Research Article Infectious disease Microbiology

Bladder catheterization increases susceptibility to infection that can be prevented by prophylactic antibiotic treatment

Abstract

Catheter-associated urinary tract infections (CAUTI) are the most common hospital-associated infections. Here, we report that bladder catheterization initiated a persistent sterile inflammatory reaction within minutes of catheter implantation. Catheterization resulted in increased expression of genes associated with defense responses and cellular migration, with ensuing rapid and sustained innate immune cell infiltration into the bladder. Catheterization also resulted in hypersensitivity to Enterococcus faecalis and uropathogenic Escherichia coli (UPEC) infection, in which colonization was achieved using an inoculum 100-fold lower than the ID90 for infection of an undamaged urothelium with the same uropathogens. As the time of catheterization increased, however, colonization by the Gram-positive uropathogen E. faecalis was reduced, whereas catheterization created a sustained window of vulnerability to infection for Gram-negative UPEC over time. As CAUTI contributes to poorer patient outcomes and increased health care expenditures, we tested whether a single prophylactic antibiotic treatment, concurrent with catheterization, would prevent infection. We observed that antibiotic treatment protected against UPEC and E. faecalis bladder and catheter colonization as late as 6 hours after implantation. Thus, our study has revealed a simple, safe, and immediately employable intervention, with the potential to decrease one of the most costly hospital-incurred infections, thereby improving patient and health care economic outcome.

Authors

Matthieu Rousseau, H.M. Sharon Goh, Sarah Holec, Matthew L. Albert, Rohan B.H. Williams, Molly A. Ingersoll, Kimberly A. Kline

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Figure 3

Susceptibility to infection by uropathogens is altered with increasing time after catheterization.

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Susceptibility to infection by uropathogens is altered with increasing t...
(A and B) Naive female C57BL/6 mice were implanted with catheters and infected with the indicated inocula of E. faecalis strain OG1RF or UPEC strain UTI89. Mice were sacrificed 24 hours after infection, and CFU per bladder and per catheter were determined for animals infected with (A) E. faecalis or (B) UPEC. (C) The schematic depicts the experimental approach used in D and E. Briefly, naive female mice were implanted with catheters and infected at the same time or at the indicated time point after catheterization with 1 × 104 CFU of E. faecalis or UPEC. All animals were sacrificed 24 hours after infection, and CFU per bladder and per catheter were calculated for (D) E. faecalis or (E) UPEC. Each dot represents 1 mouse. Black dots represent animals that were colonized exclusively by the organism inoculated into the bladder. Blue dots indicate animals that were colonized by UPEC and another bacterial species, but the plotted value reflects only the UPEC CFU. The red dotted line represents the lower limit of detection. Experiments were performed 3–5 times (n = 5–10 mice per experimental group) and pooled. The presence of the catheter was verified at the time of sacrifice, and mice without a catheter were excluded from the analysis. *P < 0.05, **P < 0.01 for experimental groups compared with the control 0 h group, Kruskal-Wallis test with Dunn’s post-test to correct for multiple comparisons.