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

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.