Intestinal carriage of Escherichia coli in prepubertal girls without a history of urinary tract infection was examined by collecting weekly stools and periurethral and urine samples over 3 to 4 weeks of study. Dominant and minor clones were defined by grouping 28 E. coli isolates into clonal types. Multiple enteric clones of E. coli, which changed week to week, were found in the 13 girls during the study (median, 3 clones/girl; range, 1 to 16 clones/girl). Dominance of an enteric clone did not predict persistence in the stool. In only 10 (34%) of the 29 episodes in which a dominant clone present in one weekly sample could have been detected the following week did it persist as the dominant clone in the next weekly sample. In 5 (17%) of the 29 episodes, a dominant clone found in one weekly sample was classified as a minor clone the next week. Both dominant and minor clones were observed to colonize the urinary tract. However, when colonization of the periurethra or bladder urine occurred, it was brief and often did not reflect the dominant stool flora from the same week. In fact, in only 40% of episodes was a clone that was detected either on the periurethra or in the urine also recovered from the stool the same week. Our findings suggest that the intestinal flora of healthy girls is multiclonal with frequent fluctuations in composition.Escherichia coli organisms infecting the urinary tract are thought to originate in the intestinal flora. There are two theories that attempt to explain infection of the urinary tract with E. coli derived from the intestine (12). The prevalence theory holds that the numerically dominant fecal strain is most likely to infect the urinary tract. The special-pathogenicity theory holds that a special subset of the intestinal microflora expressing specific virulence markers is most likely to infect the urinary tract. Virulence markers have been defined based on their higher frequency in E. coli isolates from patients with urinary tract infection (UTI) than among the dominant fecal strains of the UTI patient (5, 8, 13) or of healthy controls (6,7,18). Support for either theory relies on examination of the dominant strain in the stool at the time infection of the urinary tract occurs. Drawing conclusions from comparison of strains infecting the urinary tract to the dominant strain in stool is predicated on the notion that the dominant strain in an individual's stool is stable over time. The stability of dominant clones and the frequency of transfer of dominant clones to the urinary tract in healthy controls are therefore important background information for interpreting findings in patients with UTI.Few studies have examined carriage of dominant clones in the intestines of healthy controls (3,4,16). In the present study, we examined the intestinal carriage of E.coli in healthy girls without the confounding variables of antibiotic pressure, estrogenization, or sexual activity. For this, stool, periurethral, and urine samples were obtained weekly from prepubertal females. Dominant and minor ...

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Urinary tract infections (UTI) are one of the most common infections in children and symptoms may be nonspecific. The risk of renal scarring is highest in children under 1 year of age with febrile UTI and high-grade vesicoureteral reflux (VUR). Although treatment of UTI is usually straightforward, given increased rates of antimicrobial resistance worldwide, the choice of treatment for pediatric UTI should be guided by community resistance patterns whenever feasible. The benefit of antimicrobial prophylaxis after first UTI and/or in the presence of VUR remains controversial, but a recent meta-analysis supports continuous antimicrobial prophylaxis in children with VUR, indicating a need for more research in this area.

In the office laboratory of our private practice, the sensitivity of a single rapid antigen detection (RAD) test for group A streptococci (compared with backup throat culture) was examined over 3 winter periods. When cultures were held only 24 hours, the sensitivity was 92%; in the second period, when cultures were held to 48 hours, the sensitivity declined significantly to 86%; when the cultures were read without knowledge of the RAD test result, the sensitivity was 85%. As the Red Book Committee has suggested, physician office laboratories should validate the sensitivity of their RAD test against culture onto blood agar before abandoning the backup throat culture.

Patients with persistent bacteriuria or recurrent urinary tract infections had significant B cell infiltration in the submucosa, including lymphoid nodules. These inflammatory changes are likely due to antigenic stimulation from repeated exposure to bacteria. These changes are associated with frequent absence of uroplakin on surface epithelium.

ABSTRACT. Objective. The frequency of bacteriuria is high in children with neurogenic bladder on intermittent catheterization for bladder emptying. In an effort to decrease bacteriuria, we examined whether the method of catheter care was responsible for the high rate of bacteriuria. For this, the frequency of bacteriuria was examined in the same patient on single-use sterile catheters and on reused clean catheters.Methods. A prospective, randomized, crossover trial was conducted with 10 patients who were randomized to 4 months of a new, sterile catheter for intermittent catheterization and 4 months of reuse of a clean catheter for intermittent catheterization. Each week, a urine sample was collected and symptoms of infection and medication use were recorded.Results T he majority of children with neurogenic bladder have loss of control over voiding; urinary retention and bladder distention usually occur in the absence of intervention. Obstruction caused by urinary retention may lead to deterioration of the urinary tract. In addition, urinary retention may result in reflux into the upper urinary tract and subsequent renal damage. 1 Several strategies for complete emptying of the bladder on a regular basis have been tried. [2][3][4][5] Intermittent catheterization (IC) of the bladder several times daily is the preferred method of bladder emptying in patients with neurogenic bladder. 6 -10 A disadvantage of IC is the inoculation of bacteria into bladder urine during the course of repeated catheterization. 11 As a result, bacteriuria is frequent in urine samples collected from patients who are on IC. 12 In an effort to decrease bacteriuria and subsequent urinary tract infection (UTI) in this population, investigators compared sterile IC with clean IC. 13,14 They found no significant difference in the number of positive urine cultures in the group on IC and sterile technique compared with a second group on IC and clean technique.For the next step in an effort to decrease bacteriuria in patients who are on IC, we compared the effect of sterile, single-use catheters with reused, clean catheters in patients who are on IC. Our study was the first prospective, randomized, crossover trial of single, sterile versus reused, clean catheters in outpatients with neurogenic bladder attributable to myelomeningocele. METHODS PatientsPatients who had neurogenic bladder and were on IC 4 times per day were enrolled if they lived at home and had a normal renal ultrasound and no reflux on voiding cystourethrogram. The frequency of bacteriuria in our study group is 75%. 12 All patients continued to receive medical care from their primary physician; no therapies were withheld or altered. The urine cultures obtained for the study did not influence the patient's care, because the results were kept on file by a research technologist and were not available to either the patient's physician or the investigator. The protocol was approved by the University of Virginia Human Investigation Committee.Ten patients enrolled and completed study. Two f...