Bacterial attachment to urinary-tract epithelium is important in the pathogenesis of urinary-tract infection. Most pyelonephritogenic Escherichia coli bind specifically to epithelial-cell receptors, which are glycolipids of the globoseries and also antigens in the P blood-group system. Among 36 girls with recurrent pyelonephritis who did not have vesicoureteral reflux, we found that attaching bacteria were common and the P1 blood-group phenotype was present in 97 per cent, as compared with 75 per cent of 84 age-matched children without urinary-tract infection (P less than 0.01). In 32 girls with recurrent pyelonephritis who had reflux, attaching bacteria were rare, and the frequency of the P1 phenotype was not significantly higher than in controls (82 per cent, P greater than 0.05). In the group of patients with the P1 phenotype, 68 per cent of the urinary bacterial isolates from those without reflux, but only 25 per cent of isolates from those with reflux, bound to globotetraosylceramide, as determined by a receptor-coating technique (P less than 0.001). Our data suggest that, in the absence of reflux, the P1 blood group contributes to susceptibility to recurrent pyelonephritis due to bacteria that bind to the glycolipid receptors of the globoseries. In the presence of reflux, uroepithelial attachment does not seem to confer an advantage to bacteria that infect the kidney.

Virulence-associated properties of 606 urinary isolates from 174 children with urinary tract infections were related to severity of infection and factors increasing host susceptibility, e.g., vesicoureteral reflux (grade II or higher) and P1 blood group phenotype. A high proportion of strains of Escherichia coli causing first or recurrent episodes of acute pyelonephritis in children without reflux expressed the previously noted high frequency of certain O antigens, resistance to serum killing, hemolysin production, and adhesive capacity. A significantly lower frequency of these traits and a higher frequency of non-E. coli were seen among isolates from children with pyelonephritis and reflux, cystitis, and asymptomatic bacteriuria. Reflux was thus found to be a determinant of the level of infection and of the bacterial properties required to produce pyelonephritis. Efforts aimed at preventing or treating urinary tract infection by interfering with "virulent" bacteria may be of less value in patients with recurrent pyelonephritis and reflux, who are most likely to develop renal scars.

Escherichia coli strains with defined receptor specificity were used as probes to analyze the individual variation in host cell receptors with respect to blood groups. The adhesins were initially characterized as mannose sensitive (MS), mannose resistant (MR), or nonagglutinating (-). The receptor specificity of the strains with MR adhesins was defined by agglutination of synthetic Galkl-4Galp covalently linked via a spacer arm, (CH2)2S(CH2)2CO-H-bovine serum albumin (BSA) to BSA-latex beads as specific for the globoseries glycolipid receptors (MR:GS). Strains with MR adhesins not reacting with Gala1-4Gal0-BSAlatex were designated MR:nonGS. The attachment and hemagglutination of the MR:GS strains was strictly dependent on Galal-*4Galp-containing receptors, as shown by the absence of binding to cells from individuals of blood group P lacking these structures. Previous reports showed differences in the composition of globoseries glycolipids between erythrocytes from individuals of P1 and P2. No significant difference was found, However, in the the mean adhesion to P1 and P2 epithelial cells or in the agglutination titer for P1 and P2 erythrocytes. The MR:GS receptors were equally distributed on squamous and transitional epithelial cells. In contrast, the distribution of MR:nonGS receptors was skewed. Attachment occurred mostly to squamous epithelial cells. The attachment of strains with MR:nonGS adhesins was independent of the P blood group of the cell donor. The binding ability of MR:GS and MR:nonGS adhesins appeared independent and additive. The attachment was not influenced by the ABH blood group. However, increased binding to epithelial cells from nonsecretors occurred regardless of the P blood group, suggesting a shielding of receptors by products controlled by the secretor genes. These results illustrate how individual variation in cell surface components with and without receptor activity determine the interaction of a ligand with a known receptor. Adhesive capacity is a virulence factor for Escherichia coli causing upper urinary tract infection (25). The attachment results from the interaction of host cell receptors with bacterial surface structures known as adhesins (14). Since the exact structures of the adhesins remain to be determined, they are classified according to either target cell specificity or, in some instances, receptor specificity (when the receptor structure has been identified). Wild-type bacteria, e.g., urinary E. coli isolates, can coexpress several adhesins, even on a single bacterial cell (5, 10). Receptors for attaching bacteria can consist of host cell surface carbohydrates, i.e., either glycoproteins or glycolipids (12). Several glycoconjugate specificities have been suggested to mediate adhesion or hemagglutination of uropathogenic E. coli, including mannose (19), N-acetylglucosamine (27), M antigen (28), NeuAca2-3Gal (21), and 919

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The present study illustrates that prophylactic anti-emetic administration of ondansetron is effective in preventing nausea and vomiting in patients undergoing fractionated radiotherapy of the abdomen.