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 4

Antibiotic administration at the time of catheterization prevents infection for 6 hours.

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Antibiotic administration at the time of catheterization prevents infect...
Trimethoprim/sulfamethoxazole (TMP-SMZ), carbenicillin, or PBS was administered intraperitoneally to naive female mice concurrent with catheter implantation. Cohorts of animals were then infected with approximately 1 × 104 CFU of (A and B) UPEC or (C and D) E. faecalis at the same time (A and C) or at the indicated time point after catheterization (B and D), CFU per bladder and catheter were assessed 24 hours following infection. Each dot represents 1 mouse, and the experiment was performed 3 times (n = 7 mice per experimental group) and pooled. Black dots represent animals that were colonized exclusively by the organism inoculated into the bladder. Red dots represent animals that were negative for UPEC, but positive for an unknown bacterial species. Blue dots indicate animals that were colonized by (A and B) UPEC and another bacterial species or by (C and D) E. faecalis and another bacterial species. In both cases, the blue dot reflects the value of UPEC or E. faecalis CFU only. 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, ***P < 0.001, ****P < 0.0001 for comparison of PBS-treated groups to antibiotic-treated groups, Kruskal-Wallis test with Dunn’s post-test to correct for multiple comparisons.