Combinatorial small-molecule therapy prevents uropathogenic Escherichia coli catheter-associated urinary tract infections in mice.
Catheter-associated urinary tract infections (CAUTIs) constitute the majority of nosocomial urinary tract infections (UTIs) and pose significant clinical challenges. These infections are polymicrobial in nature and are often associated with multidrug-resistant pathogens, including uropathogenic Escherichia coli (UPEC). Urinary catheterization elicits major histological and immunological alterations in the bladder that can favor microbial colonization and dissemination in the urinary tract. We report that these biological perturbations impact UPEC pathogenesis and that bacterial reservoirs established during a previous UPEC infection, in which bacteriuria had resolved, can serve as a nidus for subsequent urinary catheter colonization. Mannosides, small molecule inhibitors of the type 1 pilus adhesin, FimH, provided significant protection against UPEC CAUTI by preventing bacterial invasion and shifting the UPEC niche primarily to the extracellular milieu and on the foreign body. By doing so, mannosides potentiated the action of trimethoprim-sulfamethoxazole in the prevention and treatment of CAUTI. In this study, we provide novel insights into UPEC pathogenesis in the context of urinary catheterization, and demonstrate the efficacy of novel therapies that target critical mechanisms for this infection. Thus, we establish a proof-of-principle for the development of mannosides to prevent and eventually treat these infections in the face of rising antibiotic-resistant uropathogens.
Department of Molecular Microbiology and Microbial Pathogenesis, Washington University School of Medicine, St. Louis, Missouri, USA,.
Pascale S
PS
Guiton
Corinne K
CK
Cusumano
Kimberly A
KA
Kline
Karen W
KW
Dodson
Zhenfu
Z
Han
James W
JW
Janetka
Jeffrey P
JP
Henderson
Michael G
MG
Caparon
Scott J
SJ
Hultgren
D018830:Adhesins, Escherichia coli / Q000235:genetics; D000818:Animals; D001422:Bacterial Adhesion / Q000187:drug effects; D018441:Biofilms / Q000187:drug effects / Q000254:growth & development; D055499:Catheter-Related Infections / Q000188:drug therapy* / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D004359:Drug Therapy, Combination; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D036781:Fimbriae Proteins / Q000172:deficiency / Q000235:genetics; D017353:Gene Deletion; D008362:Mannosides / Q000494:pharmacology* / Q000627:therapeutic use; D051379:Mice; D008810:Mice, Inbred C57BL; D008970:Molecular Weight; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology* / Q000627:therapeutic use; D001743:Urinary Bladder / Q000187:drug effects / Q000382:microbiology; D062885:Urinary Catheters / Q000382:microbiology; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D056689:Uropathogenic Escherichia coli / Q000187:drug effects* / Q000254:growth & development / Q000472:pathogenicity
D018830:Adhesins, Escherichia coli; D008362:Mannosides; C058769:fimH protein, E coli; D036781:Fimbriae Proteins; D015662:Trimethoprim, Sulfamethoxazole Drug Combination