Macrophage inflammatory protein-2, neutrophil recruitment and bacterial persistence in an experimental mouse model of urinary tract infection

This study analyzed macrophage inflammatory protein-2 (MIP-2) production and neutrophil recruitment in urinary tract in response to Pseudomonas aeruginosa in an ascending model of urinary tract infection (UTI) in mice. Both planktonic and biofilm cells of P. aeruginosa were used for inducing UTI in mice. MIP-2 levels determined in urine, bladder and kidney showed maximum MIP-2 production 6 h postinfection, which correlated with neutrophil recruitment. Biofilm cells showed significantly more MIP-2 production and neutrophil recruitment. However, no correlation between bacterial numbers and neutrophil recruitment was observed in urine and kidney tissue. The role of MIP-2 and neutrophils in relation to the persistence of P. aeruginosa in the urinary tract of mice is discussed.     

Biofilm formation of Klebsiella pneumoniae on urethral catheters requires either type 1 or type 3 fimbriae

Urinary catheters are standard medical devices utilized in both hospital and nursing home settings, but are associated with a high frequency of catheter-associated urinary tract infections (CAUTI). In particular, biofilm formation on the catheter surface by uropathogens such as Klebsiella pneumoniae causes severe problems. Here we demonstrate that type 1 and type 3 fimbriae expressed by K.?pneumoniae enhance biofilm formation on urinary catheters in a catheterized bladder model that mirrors the physico-chemical conditions present in catheterized patients. Furthermore, we show that both fimbrial types are able to functionally compensate for each other during biofilm formation on urinary catheters. In situ monitoring of fimbrial expression revealed that neither of the two fimbrial types is expressed when cells are grown planktonically. Interestingly, during biofilm formation on catheters, both fimbrial types are expressed, suggesting that they are both important in promoting biofilm formation on catheters. Additionally, transformed into and expressed by a nonfimbriated Escherichia coli strain, both fimbrial types significantly increased biofilm formation on catheters compared with the wild-type E.?coli strain. The widespread occurrence of the two fimbrial types in different species of pathogenic bacteria stresses the need for further assessment of their role during urinary tract infections.     

Contribution of macrophage secretory products to urovirulence of Pseudomonas aeruginosa

Macrophages form one of the first lines of defense on mucosal surfaces like urinary tract, providing protection against pathogens. These cells pour their secretory products, which include a cocktail of biomolecules, at the site of infection. In the present investigation, the effect of macrophage secretory products (MSPs) obtained after interaction of macrophages with Pseudomonas aeruginosa on the virulence of this organism in planktonic and biofilm cell mode was assessed employing a mouse model of ascending pyelonephritis. When urinary tract infection (UTI) was established with P. aeruginosa grown in the presence of 30% MSPs, the extent of pyelonephritis was enhanced. Of the two cell forms, biofilm cells had an edge over the planktonic cells with respect to in vivo virulence. The enhanced virulence of MSP-grown P. aeruginosa may be attributed to increased production of quorum-sensing systems as well as increased adherence to uroepithelial cells and evasion of phagocytosis. The results of the present study reveal that macrophages can play a key role during the course of UTI, not only through their phagocytic activity, but also through effects mediated by their secretory products. Utilization of MSPs by P. aeruginosa can have far-reaching consequences, including chronicity and recurrence of infections caused by this pathogen.     

Mouse models of short- and long-term foreign body in the urinary bladder: analogies to the bladder segment of urinary catheters.

Catheter-associated bacteriuria is the most common infection occurring in hospitals, where urethral catheters are generally in place for a few days, and in nursing homes, where catheters may be in place for months or years. We developed murine models with intrabladder urinary catheters for studying complications of bacteriuria in short- and long-term catheterization. In the short-term model, a catheter segment was inserted transurethrally and lay free within the bladder lumen. Half of the animals expelled segments during a 2-to-7-day period, durations similar to catheterizations in hospitalized patients. For studies of long-term catheter use, the catheter segment was secured within the bladder by a single suture for up to 12 months. Antibiotics administered for 7 days after catheter placement and housing mice in cages with wire screen floors reduced spontaneous bacteriuria to an acceptably low incidence rate of only 7%. Proteus mirabilis bacteriuria of high concentration provoked the same complications that are common in patients with long-term catheters: acute pyelonephritis, chronic renal inflammation, and struvite stone formation. These models allow inoculation of the bacteria of interest and are suitable for studies of short- and long-term foreign body-associated bacteriuria and its complications.     

泌尿系感染病原菌分布及耐药性分析

目的了解深圳市人民医院泌尿系感染病原菌的分布及耐药性,为临床医师合理使用抗菌药物提供科学依据。方法对655株泌尿系统感染病原菌进行常规鉴定,用k-B法或ATB-FUNGUS 3对其进行药敏试验。结果病原菌构成比前5位分别为大肠埃希菌（37.9%）、假丝酵母（18.0%）、肠球菌（13.1%）、肺炎克雷伯菌（6.6%）、铜绿假单胞菌（6.3%）。病原菌对各种抗菌药物产生了不同程度的耐药,肺炎克雷伯菌、铜绿假单胞菌对亚胺培南和美罗培南的耐药率为14.3%～26.8%。结论深圳市人民医院泌尿系感染病原菌主要以大肠埃希菌、假丝酵母和肠球菌等为主,病原菌对抗菌药物已产生了一定的耐药性,应加强监测与控制。     

Pseudomonas aeruginosa biofilm: Potential therapeutic targets

Pseudomonas aeruginosa is a gram-negative pathogen that has become an important cause of infection, especially in patients with compromised host defense mechanisms. It is frequently related to nosocomial infections such as pneumonia, urinary tract infections (UTIs) and bacteremia. The biofilm formed by the bacteria allows it to adhere to any surface, living or non-living and thus Pseudomonal infections can involve any part of the body. Further, the adaptive and genetic changes of the micro-organisms within the biofilm make them resistant to all known antimicrobial agents making the Pseudomonal infections complicated and life threatening. Pel, Psl and Alg operons present in P. aeruginosa are responsible for the biosynthesis of extracellular polysaccharide which plays an important role in cell–cell and cell–surface interactions during biofilm formation. Understanding the bacterial virulence which depends on a large number of cell-associated and extracellular factors is essential to know the potential drug targets for future studies. Current novel methods like small molecule based inhibitors, phytochemicals, bacteriophage therapy, photodynamic therapy, antimicrobial peptides, monoclonal antibodies and nanoparticles to curtail the biofilm formed by P. aeruginosa are being discussed in this review.     

Polycrylamide gel electrophoresis analysis of lipopolysaccharide from Pseudomonas aeruginosa growing planktonically and as biofilm

Abstract Lipopolysaccharide (LPS, endotoxin) was extracted from biofilm and planktonically grown monoagglutinable (1118) and polyagglutinable (258 and 15703) strains of Pseudomonas aeruginosa isolated from cystic fibrosis patients with chronic pulmonary infections. Analysis by polyacrylamide gel electrophoresis (PAGE) followed by immune-detection of LPS fractions showed an S-form appearance of strain 1118 and 258 with three distinct clusters of high molecular weight bands, whereas 15703 appeared semi-rough. LPS of semi-rough cells grown planktonically and as biofilm showed a very similar PAGE pattern; however, the core/lipid A R-LPS fraction was more prominent in biofilm-LPS than in planktonic-LPS extracted from the S-form bacteria (1118 and 258). The apparent change in LPS sub-unit components of the bacteria when grown as biofilm may reflect changes in the outer membrane structure that contribute to the altered physico-chemical properties of biofilm bacteria in foreign-device associated infections and chronic P. aeruginosa lung infection in cystic fibrosis patients.     

Effect of the adhesive antibiotic TA on adhesion and initial growth of E. coli on silicone rubber

Catheter-associated urinary tract infection is the most common nosocomial infection, and contributes to patient morbidity and mortality. We investigated the effect that the TA adhesive antibiotic had on adhesion and initial growth in urine of Escherichia coli on silicone rubber. The TA antibiotic had reduced adhesion, and inhibited initial growth of the bacteria on the surface. Since adhesion and initial growth on the surface are an essential part of biofilm formation and subsequent infection, we speculate that the TA antibiotic coating might decrease the infection rate associated with indwelling urinary catheter.     

Involvement of bacterial migration in the development of complex multicellular structures in Pseudomonas aeruginosa biofilms

Detailed knowledge of the developmental process from single cells scattered on a surface to complex multicellular biofilm structures is essential in order to create strategies to control biofilm development. In order to study bacterial migration patterns during Pseudomonas aeruginosa biofilm development, we have performed an investigation with time-lapse confocal laser scanning microscopy of biofilms formed by various combinations of colour-coded P. aeruginosa wild type and motility mutants. We show that mushroom-shaped multicellular structures in P. aeruginosa biofilms can form in a sequential process involving a non-motile bacterial subpopulation and a migrating bacterial subpopulation. The non-motile bacteria form the mushroom stalks by growth in certain foci of the biofilm. The migrating bacteria form the mushroom caps by climbing the stalks and aggregating on the tops in a process which is driven by type-IV pili. These results lead to a new model for biofilm formation by P. aeruginosa.     

Early development of bacterial community diversity in emergently placed urinary catheters

ABSTRACT: BACKGROUND: Approximately 25% of hospitalized patients have a urinary catheter, and catheter associated urinary tract infection is the most common nosocomial infection in the US, causing >1 million cases/year. However, the natural history of the biofilms that rapidly form on urinary catheters and lead to infection is not well described. FINDINGS: We characterized the dynamics of catheter colonization among catheters collected from 3 women and 5 men in a trauma burn unit with different indwelling times using TRFLP and culture. All patients received antibiotic therapy. Results: Colony-forming units increased along the extraluminal catheter surface from the catheter balloon to the urethra, but no trend was apparent for the intraluminal surface. This suggests extraluminal bacteria come from periurethral communities while intraluminal bacteria are introduced via the catheter or already inhabit the urine/bladder. Richness of operational taxonomic units (OTUs) increased over time on the intraluminal surface, but was constant extraluminally. CONCLUSIONS: OTU community composition was explained best by time rather than axial location or surface. Our results suggest that catheter colonization can be very dynamic, and possibly have a predictable succession.     

Aminoglycoside resistance rates, phenotypes, and mechanisms of Gram-negative bacteria from infected patients in upper Egypt

With the re-emergence of older antibiotics as valuable choices for treatment of serious infections, we studied the aminoglycoside resistance of Gram-negative bacteria isolated from patients with ear, urinary tract, skin, and gastrointestinal tract infections at Minia university hospital in Egypt. Escherichia coli (mainly from urinary tract and gastrointestinal tract infections) was the most prevalent isolate (28.57%), followed by Pseudomonas aeruginosa (25.7%) (mainly from ear discharge and skin infections). Isolates exhibited maximal resistance against streptomycin (83.4%), and minimal resistance against amikacin (17.7%) and intermediate degrees of resistance against neomycin, kanamycin, gentamicin, and tobramycin. Resistance to older aminoglycosides was higher than newer aminoglycosides. The most common aminoglycoside resistance phenotype was that of streptomycin resistance, present as a single phenotype or in combination, followed by kanamycin-neomycin as determined by interpretative reading. The resistant Pseudomonas aeruginosa strains were capable of producing aminoglycoside-modifying enzymes and using efflux as mechanisms of resistance. Using checkerboard titration method, the most frequently-observed outcome in combinations of aminoglycosides with β-lactams or quinolones was synergism. The most effective combination was amikacin with ciprofloxacin (100% Synergism), whereas the least effective combination was gentamicin with amoxicillin (53.3% Synergistic, 26.7% additive, and 20% indifferent FIC indices). Whereas the studied combinations were additive and indifferent against few of the tested strains, antagonism was never observed. The high resistance rates to aminoglycosides exhibited by Gram-negative bacteria in this study could be attributed to the selective pressure of aminoglycoside usage which could be controlled by successful implementation of infection control measures.     

铜绿假单胞菌生物膜分散的研究近况

细菌分泌胞外多糖附着在物体表面组成一个结构性群体即生物膜,导致对抗生素的强抵抗性和感染的迁延不愈。反过来,已形成的生物膜也可以分散为游离菌,许多环境物质能够促进该分散过程,并且这些物质与抗生素合用对生物膜有强大的对抗作用。从生物膜到浮游菌是个复杂的过程,目前关于铜绿假单胞菌生物膜分散的特征、机制、诱导分子等已经引起了学者的强烈兴趣,随着问题的深入研究必然会给人类治疗生物膜所致的难治性感染带来更大的意义。     

An in vitro urinary tract catheter system to investigate biofilm development in catheter-associated urinary tract infections

Biofilm development in urinary tract catheters is an often underestimated problem. However, this form of infection leads to high mortality rates and causes significant costs in health care. Therefore, it is important to analyze these biofilms and establish avoiding strategies. In this study a continuous flow-through system for the cultivation of biofilms under catheter-associated urinary tract infection conditions was established and validated. The in vitro urinary tract catheter system implies the composition of urine (artificial urine medium), the mean volume of urine of adults (1 mL min^-1), the frequently used silicone catheter (foley silicon catheter) as well as the infection with uropathogenic microorganisms like Pseudomonas aeruginosa. Three clinical isolates from urine of catheterized patients were chosen due to their ability to form biofilms, their mobility and their cell surface hydrophobicity. As reference strain P. aeruginosa PA14 has been used. Characteristic parameters as biofilm thickness, specific biofilm growth rate and substrate consumption were observed. Biofilm thicknesses varied from 105 ± 16 μm up to 246 ± 67 μm for the different isolates. The specific biofilm growth rate could be determined with a non invasive optical biomass sensor. This sensor allows online monitoring of the biofilm growth in the progress of the cultivation.     

A theoretical and experimental analysis of bacterial growth in the bladder

A mathematical model of human micturition dynamics and bacterial growth predicts the population growth rate required for a bladder infection to become established in the absence of adhesin-mediated surface growth. Escherichia coli strains isolated from the urinary tract have significantly higher in vitro growth rates in urine than strains isolated from the intestinal flora. The results suggest that, for E. coli isolated from the urinary tract, adhesin-mediated surface growth may not be required for infections to become established and persist. The growth-rate differences observed between urinary tract and intestinal isolates suggests that the ability to survive and efficiently utilize the resources available in urine is an important adaptation for E. coli inhabiting the urinary tract.     

79例重症监护病房患者院内感染病原菌分布分析

目的了解重症监护病房（ICU）院内感染情况,更好地指导有针对性的用药和治疗。方法医院感染管理人员根据病历报告进行回顾性分析,菌种鉴定遵循美国临床和实验室标准化研究所（CLSI）2007年制定的标准,应用SPSS 12.0软件建立数据库并进行统计分析。结果 ICU的院内感染发生率为23.0%,原发疾病集中于脑血管意外和多发复合伤,院内感染患者感染部以下呼吸道和泌尿系感染比例最高,医院感染病例病原菌送检率44.5%,分离出的病原菌以革兰阴性菌为主55.4%,占,其次为革兰阳性菌占35.9%,真菌占8.7%,分离率居前5位的病原菌依次为大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌和肠球菌。结论 ICU院内感染情况严重,应加强预防。     

Ureteral stent-associated infection and sepsis: pathogenesis and prevention: a review

Ureteral stents are commonly used devices in hospital settings. However, their usage is often complicated by associated urinary tract infections as a result of bacterial adhesion onto the indwelling implant surfaces, followed by the formation of layers of biofilm. Once formed, the biofilm is exceedingly difficult to remove, potentially leading to further morbidity and even urosepsis. Urosepsis, where pathogens from the urinary tract enter the bloodstream, has a mortality rate of up to 50% of severely infected patients. Hence, it is important to understand its pathogenesis. In this review, ureteral stent-associated urinary tract infection and urosepsis will be addressed. In particular, the bacterial mechanisms involved, as well as the prevention and treatment of these infections will be discussed.     

Development of intracellular bacterial communities of uropathogenic Escherichia coli depends on type 1 pili

Uropathogenic Escherichia coli, the predominant causative agent of urinary tract infections, use type 1 pili to bind and invade bladder epithelial cells. Upon entry, the bacteria rapidly replicate and enter a complex developmental pathway ultimately forming intracellular bacterial communities (IBCs), a niche with biofilm-like properties protected from innate defences and antibiotics. Paradoxically, bacteria within IBCs produce type 1 pili, an organelle thought only to be an extracellular colonization factor. Thus, we investigated the function of type 1 pili in IBC development. The cystitis isolate, UTI89, was genetically manipulated for conditional fim expression under control of the tet promoter. In this strain, UTI89-tetR/P(tet) fim, piliation is constitutively inhibited by the tetracycline repressor, TetR. Repression is relieved by anhydrotetracycline (AHT) treatment. UTI89-tetR/P(tet) fim and the isogenic control strain, UTI89-tetR, grown in the presence of AHT, colonized the bladder and invaded the superficial umbrella cells at similar levels at early times in a murine model of infection. However, after invasion UTI89-tetR/P(tet) fim became non-piliated and was unable to form typical IBCs comprised of tightly packed, coccoid-shaped bacteria in contrast to the control strain, UTI89-tetR. Thus, this work changes the extracellular colonization functional paradigm of pili by demonstrating their intracellular role in biofilm formation.     

红霉素、氨溴索与环丙沙星雾化吸入对实验大鼠铜绿假单胞菌生物膜的影响

目的研究红霉素和氨溴索分别联合环丙沙星雾化吸入对铜绿假单胞菌成熟生物膜的干预效果。方法平板法培养成熟铜绿假单胞菌生物膜;微量肉汤稀释法测量红霉素和环丙沙星的最低抑菌浓度;制作气管插管铜绿假单胞菌生物膜感染模型;平板计数法计算红霉素、氨溴索分别联合环丙沙星对生物膜菌落数的影响;日本岛津紫外-可见光分光光度计UV1700测铜绿假单胞菌菌液的A值;石蜡切片HE染色定性观察肺组织的炎症情况;扫描电镜定性观察各处理组的生物膜结构变化。结果各处理组干预7 d后肺组织细菌菌落计数（×10^4CFU/m l）：干预组分为：生理盐水对照,氨溴索,红霉素,红霉素联合环丙沙星,氨溴索联合环丙沙星,各组分别为139.250±42.0162、101.625±40.4190、109.625±33.4747、57.750±37.8295和22.250±17.3184,前3组与后2组对比差异均有显著性（P〈0.05）,前3组之间对比差异没有显著性（P〉0.05）,后2组对比差异有显著性（P〈0.05）。导管生物膜细菌菌落计数（×10^4CFU/m l）：5组分别为170.000±48.3263、127.625±39.0163、133.500±33.6876、70.375±35.7768和38.125±19.1045,结论和肺组织菌落计数是一致的。导管生物膜电镜观察：第1组导管内表面均有较厚基质覆盖,2、3组减少不明显,而联合用药组导管内表面生物膜明显减少,其中第5组效果更好。结论氨溴索与红霉素分别联合环丙沙星雾化吸入在控制导管生物膜和呼吸系统相关感染均具有显著效果,其中氨溴索联合环丙沙星疗效更好。     

Community behavior and amyloid-associated phenotypes among a panel of uropathogenic E. coli

Uropathogenic Escherichia coli (UPEC) are the major causative agents of urinary tract infection and engage in a coordinated genetic and molecular cascade to colonize the urinary tract. Disrupting the assembly and/or function of virulence factors and bacterial biofilms has emerged as an attractive target for the development of new therapeutic strategies to prevent and treat urinary tract infection, particularly in the era of increasing antibiotic resistance among human pathogens. UPEC vary widely in their genetic and molecular phenotypes and more data are needed to understand the features that distinguish isolates as more or less virulent and as more robust biofilm formers or poor biofilm formers. Curli are extracellular functional amyloid fibers produced by E. coli that contribute to pathogenesis and influence the host response during urinary tract infection (UTI). We have examined the production of curli and curli-associated phenotypes including biofilm formation among a specific panel of human clinical UPEC that has been studied extensively in the mouse model of UTI. Motility, curli production, and curli-associated biofilm formation attached to plastic were the most prevalent behaviors, shared by most clinical isolates. We discuss these results in the context on the previously reported behavior and phenotypes of these isolates in the murine cystitis model in vivo.     

人体泌尿系微生物感染与耐药及宿主状态分析

目的了解泌尿系感染常见病原细菌和真菌分布、耐药性及宿主相关状态,为理解相关微生物感染影响因素及临床合理用药提供资料和依据。方法对门诊及住院患者中段尿培养分离的179株病原细菌和真菌进行微生物学鉴定和K-B法药敏试验,同时记录门诊和住院的菌株相关的泌尿系感染患者情况。结果泌尿系感染微生物以大肠埃希菌居首位,占62.4%,其次为真菌和肠球菌,各占12.4%、14.0%。药敏结果显示,大肠埃希菌产ESBLs占62.2%;肠杆菌科细菌对亚胺培南、美罗培南的敏感率为100%,其次敏感性较好的为氨基糖苷类阿米卡星、头孢头霉类头孢西丁及第三代头孢类头孢哌酮/舒巴坦、头孢他啶,敏感率均大于80%。革兰阳性球菌万古霉素敏感率为100%,对呋喃妥因敏感率为70.8%。大肠埃希菌感染率与患者的身体状态和行为具有显著的相关性(P<0.01)。结论革兰阴性杆菌是泌尿系感染的主要病原菌,机体免疫状态低下、不洁等生活行为与尿路微生物感染密切相关,但与耐药性不相关。维护机体正常免疫力、注意合适的生活行为,对预防泌尿道病原细菌与真菌的感染十分重要。