ANAHEIM, CA (UroToday.com) - The plenary session on Monday morning was highlighted by reports from Dr. Thomas Hooton, Dr. William Costerton, and Dr. John Krieger.

Dr. Hooton discussed previously published guidelines on treatment of uncomplicated urinary tract infection and and proceeded to discuss his conclusions on a review of data regarding catheter associated urinary tract infection. He made the following points:

• 1. Use a closed catheter system
• 2. Daily meatal cleansing is not indicated
• 3. Instituting a catheter reminder system is helpful in terms of decreasing the number of catheterized patients and the number of patient-catheter days
• 4. Bladder irrigation with antibacterials is not beneficial
• 5. Systemic antibiotic therapy for bacterial colonization and to prevent infection is not recommended
• 6. The data does not permit recommendations regarding frequency of routine catheter changes
• 7. Antibiotic prophylaxis for routing catheter changes is not necessary
• 8. Antimicrobial impregnated catheters cannot be recommended at this time
• 9. There is no data regarding any efficacy of irrigation of long-term catheters to prevent encrustation.
• 10. Treat catheter-associated urinary tract infection for 7days minimum
• 11. The data does not yet support any benefit from "low friction" catheters
• He concluded that further advances in preventing UTI will require technical advances to make catheters biofilm resistant.

J. William Costerton gave a riveting talk on biofilms. In it he discussed theories and research from his new book, "The Biofilm Primer" published by Springer. He noted that plantonic (free-floating) bacteria seem to cause symptoms of infection and are sensitive to antibiotics. Biofilms are resistant to 1000X the concentration of antibiotics and resistant to antibodies as well. Slime-encased bacteria do not grow on bacterial auger plates. Urine cultures only show planktonic bacteria. He noted that a 40 minute highly accurate diagnostic test for urinary tract infection has been developed by Dr. Bernie Churchhill at UCLA.

Dr. Costerton went on to discuss how bacteria communicate with each other. By disrupting communication throught a bioelectric effect, one can impair biofilm formation and make the bacteria sensitive to antibiotic therapy. Biofilm blockers are in research testing by 6 companies, he noted, and will soon be coming to FDA for consideration. He credited David Davies at SUNY Binghamton with discovering a general detachment signal that can be used therapeutically to break up biofilms. Through the use of biofilm inhibitors, growth regulators, and developing mechanisms to cause disruption and detachment of biofilms, a revolution in preventing infection from indwelling foreign bodies may not be far off.

Dr. John Krieger reported on epidemiology and clinical studies showing that circumcision dramatically reduces the spread of HIV infection in Africa. As circumcision rates increase, HIV seroprevalence decreases. In one study in Uganda looking at HIV negative men who had infected partners, 40/137 seroconverted in the uncircumcised group and 0/50 seroconverted in the circumcised group. A subsequent randomized prospective clinical trial to address the issue of confounding was subsequently undertaken in western Kenya. 6700 men were screened and the results were consistent with the hypothesis that circumcision indeed lowers the risk of serconversion for HIV.

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Written by Philip M. Hanno, MD, a Contributing Editor with UroToday.

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