294. Targeted replacement of uropathogens with probiotic Nissle 1917
Session: Poster Abstract Session: HAIs in Children
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background:

The usefulness of prophylactic antibiotics to prevent recurrent urinary tract infections (UTI) in children has recently come into question.  Furthermore, prophylaxis antibiotic is a risk factor for selecting out more resistant uropathogens.  Some groups have used gram positive based probiotics, like lactobacillus, to prevent recurrent infections by altering the intestinal bacterial reservoir with variable results.  Nissle 1917 is a possible alternative probiotic in which the active agent is a gram negative organism.  Nissle 1917 is a commensal Escherichia coli strain that eradicates pathogenic bacteria from the gastrointestinal tract.  Due to its ability to stabalize the intestinal microbiome we hypothesized that Nissle 1917 may have the potential to prevent recurrent UTIs in children and especially those children requiring urinary catheterization to empty their bladders.  Thus, we used an in vitro assay to analyze the effectiveness of Nissle 1917 for eradicating pediatric catheter associated uropathogens.

Methods: We collected urinary catheters from patients while hospitalized.  Each catheter is cultured and with each isolate recovered, a microcin assay was performed to determine the effectiveness of Nissle 1917 on bacterial growth inhibition and competitive overgrowth.  A second assay, the competition assay assessed when Nissle 1917 was co-cultured with an isolate, which organism was more successful.   

Results:

50 separate isolates were recovered from 36 discarded catheters, however, not all isolates were considered potentially pathogenic.  Nissle 1917 adversely affected the growth of 79% of potentially pathogenic isolates using the microcin assay.  Additionally, Nissle 1917 outcompeted the pathogenic isolates 63% of the time in the competition assay.  

Conclusion:

Nissle 1917 inhibited or out competed most bacterial isolates. These mechanisms could be used in vivo to eradicate uropathogens from the gastrointestinal tract. Pending trial conclusion, the discarded urinary catheter assay could indicate a potential benefit in a population greatly burdened with frequent infections and multiple courses of antibiotics.  Further study is needed to determine whether Nissle 1917 can prevent recurrent UTIs in children.

Elizabeth Lucas, MD1, Birong Li2 and Sheryl Justice, PhD2, (1)Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, (2)Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, OH

Disclosures:

E. Lucas, Thrasher Research Fund: Grant Investigator, Research grant

B. Li, None

S. Justice, None

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