The recent advances related to bacterial adhesion and urinary tract infection have been noted in several areas. The importance of adhesion per se in pathogenesis remains clear, although the actual number of adhesin-expressing attached organisms present per bladder cell during acute and chronic infection appears to vary. Although steps have been made to examine asymptomatic infections, further investigations are required to understand the process and develop efficient ways of treating the patients, especially those with spinal cord injury. The use of alternative approaches such as immunization are in their infancy. For complicated infections related to the insertion of a prosthesis, bacterial biofilms are known to form and resist antimicrobial action on various biomaterial surfaces. The deposition of a conditioning film appears to predispose adhesion. Although antiseptic and antibiotic use can control infection to some extent, only the use of prophylactic antibiotics before implantation or large-dose therapy after insertion will have any chance of being efficacious. The problem with devices implanted for a longer duration, will be emergence of drug-resistant planktonic and adherent bacteria.
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