Despite improvement in bladder care, urine of people with spinal cord injury (SCI) is often colonized with bacteria and symptomatic urinary tract infection (UTI) is a recurrent problem for many. However, urinary colonization does not always result in symptoms. Colonization without symptoms is called asymptomatic bacteriuria (ABU). In some instances, treatment of ABU may not be warranted and benign bacteria in the bladder may even be beneficial in preventing infection by more harmful organisms. For example, there was agreement at a 1992 NIDRR sponsored Consus Validation Conference that ABU in SCI patients with indwelling catheters should be treated only if symptoms occur. Unfortunately, little is known about bacteria associated with ABU. The bacterial strain that colonizes the bladder is self-selecting and the physician has little knowledge of the potential for urovirulence of the organism. A better understanding of the virulence potential of the ABU associated organism and of its potential for long term asymptomatic bladder colonization would reduce the uncertainty involved in treatment decisions. Recent studies suggest that intentional bladder colonization with certain E.coli bacteria may help prevent UTI. In the pilot study, intentional bladder colonization of SCI subjects with a prototype ABU associated bacteria called E.coli83972 resulted in long term (> 1 yr.) colonization in participants. They had no symptoms of UTI, either from E.coli 83972 or from any invading organisms while colonized. In this project, they will study proteins on the surface of E.coli 83972 that may help the bacteria attach to components of the urinary tract in SCI patients and persist in the bladder. They hope to learn more about the mechanism for E.coli83972 bladder colonization so that this strain and perhaps other bacteria may be safely allowed to colonize the neurogenic bladder and prevent UTI.
|Darouiche, Rabih O; Thornby, John I; Cerra-Stewart, Colleen et al. (2005) Bacterial interference for prevention of urinary tract infection: a prospective, randomized, placebo-controlled, double-blind pilot trial. Clin Infect Dis 41:1531-4|
|Hull, Richard A; Donovan, William H; Del Terzo, Michael et al. (2002) Role of type 1 fimbria- and P fimbria-specific adherence in colonization of the neurogenic human bladder by Escherichia coli. Infect Immun 70:6481-4|
|Cook, S W; Hammill, H A; Hull, R A (2001) Virulence factors of Escherichia coli isolated from female reproductive tract infections and neonatal sepsis. Infect Dis Obstet Gynecol 9:203-7|
|Darouiche, R O; Donovan, W H; Del Terzo, M et al. (2001) Pilot trial of bacterial interference for preventing urinary tract infection. Urology 58:339-44|
|Hull, R; Rudy, D; Donovan, W et al. (2000) Urinary tract infection prophylaxis using Escherichia coli 83972 in spinal cord injured patients. J Urol 163:872-7|