The Journal of Urology
Volume 180, Issue 4 , Pages 1522-1526, October 2008

A Biphasic Response From Bladder Epithelial Cells Induced by Catheter Material and Bacteria: An In Vitro Study of the Pathophysiology of Catheter Related Urinary Tract Infection

  • Jessica M.T. Barford

      Affiliations

    • Corresponding Author InformationCorrespondence: Department of Cellular and Molecular Medicine, St. George's, University of London, Cranmer Terrace, London SW17 0RE, United Kingdom (telephone: +44 (0)20 8672 9944)
    • Financial interest and/or other relationship with Bactiguard.
    • ,
  • Yanmin Hu
    • ,
  • Ken Anson
    • ,
  • Anthony R.M. Coates

      Affiliations

    • Financial interest and/or other relationship with Bactiguard.

Department of Medical Microbiology, Cellular and Molecular Medicine, St. George's, University of London and Department of Urology, St. George's Hospital (KA), London, United Kingdom

Received 17 January 2008 published online 19 August 2008.

Purpose

Catheter associated urinary tract infection is the most common type of hospital acquired infection. An understanding of catheter associated urinary tract infection pathogenesis is needed to improve the control and treatment of these infections. We investigated the relationship among catheter material, bacteria and bladder epithelial cell reaction.

Materials and Methods

Urinary catheter sections and a clinical isolate of Escherichia coli were added to human bladder carcinoma epithelial cells in vitro in combination or independently. The catheters were rotated for 30 seconds over the cells, followed by incubation. The cytokines interleukin-6 and 8 were measured by enzyme-linked immunosorbent assay as indicators of inflammation and cell membrane disruption was assessed using a lactate dehydrogenase assay.

Results

The levels of lactate dehydrogenase release and cytokine production depended on the number of bacteria added. Bacteria grown for 3 days caused greater secretion of cytokines than bacteria grown overnight. Silicone catheter material alone caused immediate damage to cells with increased lactate dehydrogenase in the supernatant but little interleukin-6 or 8 production. Silicone catheters caused significantly less cytokine secretion from bladder cells than latex catheters. Conversely bacteria caused little immediate damage to cells but stimulated cytokine production after 12 hours.

Conclusions

Disruption of bladder epithelial cell membranes in vitro occurred immediately as a result of physical abrasion caused by catheters but delayed inflammation occurred in response to bacterial infection.

Key Words: bladder, urinary tract infections, cross infection, urinary catheterization, Escherichia coli

Abbreviations and Acronyms: BPRF, basic PRF, ELISA, enzyme-linked immunosorbent assay, EMEM, minimum essential medium with Earl's salts, IL, interleukin, LDH, lactate dehydrogenase, PRF, phenol red-free EMEM, UTI, urinary tract infection

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 Supported by the Pathology Research Fund (St. George's) (JB).

PII: S0022-5347(08)01543-7

doi:10.1016/j.juro.2008.06.012

The Journal of Urology
Volume 180, Issue 4 , Pages 1522-1526, October 2008

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