USE OF ADHESION COUNTS TO HELP PREDICT SYMPTOMATIC INFECTION AND THE ABILITY OF FLUOROQUINOLONES TO PENETRATE BACTERIAL BIOFILMS ON THE BLADDER CELLS OF SPINAL-CORD INJURED PATIENTS
G. Reid et al., USE OF ADHESION COUNTS TO HELP PREDICT SYMPTOMATIC INFECTION AND THE ABILITY OF FLUOROQUINOLONES TO PENETRATE BACTERIAL BIOFILMS ON THE BLADDER CELLS OF SPINAL-CORD INJURED PATIENTS, Paraplegia, 32(7), 1994, pp. 468-472
There were three objectives to the present study: (1) compare the blad
der infection rate and extent of biofilm formation for seven untreated
spinal cord injured (SCI) patients and seven given prophylactic co-tr
imoxazole, (2) identify a level of bacterial adhesion to bladder cells
which could be used to help predict symptomatic infection, and (3) de
termine from in vivo and in vitro studies whether fluoroquinolones wer
e effective at penetrating bacterial biofilms. The results showed that
the infection rate had not changed with the introduction of prophylax
is. However, the uropathogenic population had altered subsequent to th
e introduction of prophylaxis with E. coli being replaced by E. faecal
is as the most common cause of infection. In 63% of the specimens from
asymptomatic patients, the bacterial counts per cell were < 20, while
81% of specimens from patients with at least one sign and one symptom
of urinary tract infection (UTI) had > 20 adherent bacteria per bladd
er cell. Therefore, it is proposed that counts of > 20 bacteria adhere
nt to sediment transitional epithelial bladder cells may be predictive
of symptomatic UTI. Clinical data showed that fluoroquinolone therapy
reduced the adhesion counts to < 20 per cell in 63% of cases, while t
rimethoprim-sulfamethoxazole only did so in 44%. Further in vitro test
ing showed that ciprofloxacin (0.1, 0.5 and 1.0 mug/ml) partially or c
ompletely eradicated adherent biofilms from 92% of spinal cord injured
patients' bladder cells, while ofloxacin did so in 71% cases and norf
loxacin in 56%. These findings have important implications for the det
ection and treatment of bacteriuria in spinal cord injured patients.