**6. Conclusion**

been also shown to prevent urea break down and pH increase *in vitro* by *P. mirabilis* besides decreasing the associated encrustation. Another enzyme target is N-acetyl-D-glucosamine-1 phosphate acetyltransferase, which is essential for peptidoglycan, lipopolysaccharide and adhesion synthesis. Inhibitors of the enzyme belonging to the N-substituted maleimide family have produced antibiofilm activity against *P. aeruginosa* and *S. epidermidis* compared to silver

Use of nonpathogenic microorganisms to counteract pathogenic bacteria is known as bacterial interference [137]. Colonization of catheter surfaces with nonpathogenic bacteria can prevent adhesion and colonization by pathogens. The nonpathogenic *E. coli* 83972 has been extensively investigated both *in vitro* and *in vivo* in bacterial interference protocols [68]. Initially, studies with this nonpathogenic strain were done by instilling the bacteria into the bladder of patients. Colonization by *E. coli* 83972 protected these patients from symptomatic UTI. To reduce the need for instillation of bacteria into the bladder of patients, experiments were later conducted with catheters coated with the nonpathogenic strain [168]. This study also revealed that *E. coli* 83972 was effective in reducing symptomatic UTI similar to previous experiments with

Another potential approach investigated for controlling CAUTI is the use of bacteriophages. Catheters coated with T4 bacteriophage against *E. coli* and coli-proteus bacteriophage active against Proteus were exposed to *E. coli* ATCC 11303, *P. mirabilis* or saline. It was observed that phage treatment of catheters led to approximately 90% reduction in biofilm formation compared to control catheters [19]. It was also observed that the application of phage cocktail on catheters was more effective against bacteria than the use of a single phage [19]. When hydrogel coated catheters were pretreated with a five-phage cocktail, *P. aeruginosa* biofilm

Liposomes are carrier or delivery vehicles that can carry both hydrophilic and hydrophobic molecules to their target site for delivery. This helps to increase the half life of the drugs besides protecting them from the environment. Liposomes containing ciprofloxacin embedded in a hydrogel coated catheter were evaluated in a rabbit model to investigate its antibiofilm effect against *E. coli* induced CAUTI [121]. The results from this study revealed that liposomal ciprofloxacin treated group had a delayed onset of positive urine cultures compared to the

Quorum sensing between bacterial cells in a biofilm have been shown to be essential for biofilm formation and maintenance. Inhibition of quorum sensing could therefore provide a potential

hydrogel coated catheters [17].

70 Recent Advances in the Field of Urinary Tract Infections

direct infusion of the bacteria.

formation was reduced by 99% after 48 h [45].

*5.6.2. Bacteriophages*

*5.6.3. Liposomes*

control group.

*5.6.4. Quorum sensing inhibitors*

*5.6.1. Bacterial interference*

Catheter associated urinary tract infections are the most common nosocomial infections and a vast majority of them are caused by biofilms formed on catheters. The complica‐ tions caused by biofilms can undermine the patient's quality of life and threaten their health. The high incidence of CAUTI and the consequent complications warrants the de‐ velopment and application of effective control strategies. Prevention is predominantly based on enforcing guidelines for appropriate catheter placement and early removal. However, a comprehensive understanding of bacterial biofilm formation, pathogenesis and other key factors essential for development of UTIs would help in the development of novel and effective control strategies.

### **Author details**

Mary Anne Roshni Amalaradjou1 and Kumar Venkitanarayanan2


### **References**

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**Section 2**

**New Aspects in Pediatric Urinary Tract**

**Infections**

**New Aspects in Pediatric Urinary Tract Infections**

**Chapter 5**

**Developments Regarding Dysfunctional**

Additional information is available at the end of the chapter

Yusuf Kibar and Faysal Gok

http://dx.doi.org/10.5772/53569

**1. Introduction**

the clinician [1].

department [2, 5].

chronic renal insufficiency [2].

**Voiding and Urinary Tract Infections in Children**

Urinary tract infection (UTI) is the most commonly diagnosed bacterial infections of child‐ hood, and have a significant healthcare impact. Renal parenchymal infection and scarring are well-established complications of UTI in children and can lead to renal insufficiency, hy‐ pertension and renal failure. Although frequently encountered and well researched, diagno‐ sis and management of UTI continue to be a controversial issue with many challenges for

Dysfunctional voiding (DV) imposes a considerable social, developmental and physical bur‐ den on children and their families. Children that suffer from DV generally present with complaints of UTI, incontinence, constipation and voiding symptoms such as urinary urgen‐ cy and frequency. Vesicoureteral reflux (VUR) may also be present in some children with more severe DV, possibly resulting in hydronephrosis, pyelonephritis and even secondary

The true estimate of DV in the general population is not known. Reported population es‐ timates of DV are based on questionable methodology. A wide variation from 4.2-46.4% has been reported depending on the definition used and the methodology adopted [3, 4]. It is probable that these figures represent a gross overestimate of the actual prevalence. In tertiary care centres, DV constitutes up to 40% of referrals in the Paediatric Urology

This chapter will focus on the epidemiology, diagnosis and management of DV and UTI in neurologically and anatomically normal children. The discussion will highlight recent devel‐

and reproduction in any medium, provided the original work is properly cited.

© 2013 Kibar and Gok; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

opments and research in the clinical approach of DV and UTI.
