title: 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 toEnterococcus faecalisand uropathogenicEscherichia coli(UPEC) infection, in which colonization was achieved using an inoculum 100-fold lower than the ID90for infection of an undamaged urothelium with the same uropathogens. As the time of catheterization increased, however, colonization by the Gram-positive uropathogenE.faecaliswas 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 andE.faecalisbladder 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.affiliation: Unité d'Immunobiologie des Cellules Dendritiques, Department of Immunology, Institut Pasteur and INSERM U1223, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Rousseau
authors.affiliation: Singapore Centre on Environmental Life Sciences Engineering, School of Biological Sciences, Nanyang Technological University, Singapore.
authors.forename: H M Sharon
authors.initials: HMS
authors.lastname: Goh
authors.affiliation: Singapore Centre on Environmental Life Sciences Engineering, School of Biological Sciences, Nanyang Technological University, Singapore.
authors.forename: Sarah
authors.initials: S
authors.lastname: Holec
authors.affiliation: Unité d'Immunobiologie des Cellules Dendritiques, Department of Immunology, Institut Pasteur and INSERM U1223, Paris, France.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Albert
authors.affiliation: Singapore Centre for Environmental Life Sciences Engineering, National University of Singapore, Singapore.
authors.forename: Rohan Bh
authors.initials: RB
authors.lastname: Williams
authors.affiliation: Unité d'Immunobiologie des Cellules Dendritiques, Department of Immunology, Institut Pasteur and INSERM U1223, Paris, France.
authors.forename: Molly A
authors.initials: MA
authors.lastname: Ingersoll
authors.affiliation: Singapore Centre on Environmental Life Sciences Engineering, School of Biological Sciences, Nanyang Technological University, Singapore.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Kline
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D013293:Enterococcus faecalis; D004927:Escherichia coli Infections / Q000517:prevention & control; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000517:prevention & control; D007249:Inflammation / Q000503:physiopathology; D008810:Mice, Inbred C57BL; D001743:Urinary Bladder / Q000382:microbiology; D014546:Urinary Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control*; D056689:Uropathogenic Escherichia coli
chemical_list: D000900:Anti-Bacterial Agents