Abstract
Ten spinal cord injured patients aged 8 to 55 years (mean 32) were followed for up to 2 months after admisssion to a rehabilitation setting from an acute care hospital. Urinary fluid and bladder epithelial cells were collected weekly by intermittent catheterization and examined for bacterial colonization. Six patients had no history of urinary tract infection upon admission, likely due to the antimicrobial coverage given during acute care. All the patients subsequently became colonized with uropathogens at some time during the study period. Bacterial biofilms were found in 73% of the samples (73% Gram negative organisms, 27% Gram positive), with mean pathogenic adhesion counts of 29 organisms per bladder cell. In 16% of cases, bladder biofilms were found when urine culture was negative. Bacterial biofilms were also evident during antimicrobial therapy in 10 of 12 samples tested and urine cultures showed breakthrough infections in 50% of cases. Two asymptomatic patients were colonized with Klebsiella pneumoniae and Pseudomonas aeruginosa and were dismissed without requiring therapy. Clearly, bacterial biofilms can exist on bladder epithelia, without being detected in urine samples and without giving rise to symptoms. The extent to which they occur and damage the host remains to be determined, as does the answer to the question, should these patients be treated?
Similar content being viewed by others
Article PDF
References
Warren J W, Damron D, Tenney J H, Hoopes J M, Deforge B, Muncie HL J r (1987) Fever, bacteremia, and death as complications of bacteriuria in women with long-term urethral catheters. J Infect Dis 155: 1151–1158.
Warren J W, Tenney J H, Hoopes J M, Muncie H L, Anthony W C (1982) A prospective microbiological study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 146: 719–723.
Johnson J R, Stamm W E (1989) Urinary tract infections in women: diagnosis and treatment. Ann Intern Med 111: 906–917.
Stickler D J, Chawla J C (1988) An appraisal of antibiotic policies for urinary tract infections in patients with spinal cord injuries undergoing long-term intermittent catheterization. Paraplegia 26: 215–225.
Reid G, Lam D (1991) Diagnosis and therapy for urinary tract infections. Curr Opin Infect Dis 4: 42–46.
Bruce A W, Reid G . (1990) Investigation of infection of the lower urinary tract. In: O'Reilly PH, George NJR, Weiss RM, editors. Diagnostic Techniques in Urology. WB Saunders Co, Toronto: 483–489.
Reid G, Sobel J D (1987) Bacterial adherence in the pathogenesis of urinary tract infection: a review. Rev Infect Dis 9: 470–487.
Svanborg Eden C, Hanson L A, Jodal U, Lindberg U, Sohl Akerlund A (1976) Variable adherence to normal human urinary-tract epithelial cells of Escherichia coli strains associated with various forms of urinary-tract infection. Lancet 2: 490–492.
Costerton J W, Cheng K-J, Geesey G G, Ladd T I, Nickel J C, Dasgupta M et al (1987) Bacterial biofilms in nature and disease. Ann Rev Microbiol 41: 435–464.
Nickel J C, Gristina A G, Costerton J W (1985) Electron microscopic study of an infected Foley catheter. Can J Surg 28: 50–52.
Reid G, Brooks H J L (1984) In vitro attachment of Escherichia coli to human epithelial cells. N Z Med J 97: 439–442.
Reid G, Brooks H J L, Bacon D F (1983) In vitro attachment of Escherichia coli to human uroepithelial cells. Variation in receptivity during the menstrual cycle and pregnancy. J Infect Dis 148: 412–421.
Reid G, Brooks H J L (1985) A fluorescent antibody staining technique to detect bacterial adherence to urinary tract epithelial cells. Stain Technol 60: 211–217.
Kuhn W, Rist M, Zaech G A (1991) Intermittent urethral self-catheterization: long term results (bacteriological evolution, continence, acceptance, complications). Paraplegia 29: 222–232.
Anwar H, Costerton J W (1990) Enhanced activity of combination of tobramycin and piperacillin for eradication of sessile biofilm cells of Pseudomonas aeruginosa. Antimicrob Agents Chemother 34: 1666–1671.
Preston C A K, Bruce A W, Reid G (1992) Antibiotic resistance of urinary pathogens isolate from patients attending The Toronto Hospital between 1986 and 1990. J Hosp Infection 21.
Maynard F, Diokno A (1984) Urinary infection and complications during clean intermittent catheterization following spinal cord injury. J Urol 132: 943–946.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Reid, G., Charbonneau-Smith, R., Lam, D. et al. Bacterial biofilm formation in the urinary bladder of spinal cord injured patients. Spinal Cord 30, 711–717 (1992). https://doi.org/10.1038/sc.1992.138
Issue Date:
DOI: https://doi.org/10.1038/sc.1992.138
Keywords
This article is cited by
-
Is bacterial vaginosis a disease?
Applied Microbiology and Biotechnology (2018)
-
The human urinary microbiome and how it relates to urogynecology
International Urogynecology Journal (2016)
-
Probiotics to prevent urinary tract infections: the rationale and evidence
World Journal of Urology (2006)
-
Applications from bacterial adhesion and biofilm studies in relation to urogenital tissues and biomaterials: A review
Journal of Industrial Microbiology (1994)