Bacteriology and ultrastructure of the bladder in patients with urinary tract infections

Elliott, T. S. J.; Reed, L.; Slack, R. C. B.; Bishop, M. C.

doi:10.1016/s0163-4453(85)92997-4

Cited by 86 publications

(48 citation statements)

References 7 publications

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“…E. coli can persist intracellularly in the bladder epithelium, replicating and forming intracellular niches termed bacterial "factories" that can mature into biofilms, thereby constituting a very potent and stable reservoir for RUTI (1,18,23,34,35,41). The intracellularly located E. coli has been observed in mouse models for UTI and not in humans, but bacteria have been cultured from bladder tissue of women with recurrent UTIs during periods with an absence of bacteriuria (7). It has been shown that appropriate antibiotic treatment including amdinocillin that eradicates E. coli in the urine leaves the bladder reservoir unaffected (18,26,41) and capable of reestablishing an infection (26,41).…”

Section: Discussionmentioning

confidence: 99%

Pulsed-Field Gel Electrophoresis Typing of Escherichia coli Strains from Samples Collected before and after Pivmecillinam or Placebo Treatment of Uncomplicated Community-Acquired Urinary Tract Infection in Women

et al. 2006

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The primary infecting Escherichia coli strains from 156 women with community-acquired uncomplicated urinary tract infection (UTI) randomized to pivmecillinam or placebo and the E. coli strains causing UTI at two follow-up visits were typed using pulsed-field gel electrophoresis (PFGE). In the pivmecillinam treatment group PFGE showed that among patients having a negative urine culture at the first follow-up 77% (46/60) had a relapse with the primary infecting E. coli strain and 23% (14/60) had reinfection with a new E. coli strain at the second follow-up. Among patients having E. coli at the first follow-up PFGE showed that 80% (32/40) had persistence with the primary infecting E. coli strain, 15% (6/40) had reinfection with a new E. coli strain, and 5% (2/40) had different E. coli strains at the two follow-up visits (one had reinfection followed by relapse, and the other had persistence followed by reinfection). In the placebo group the majority had E. coli at the first follow-up. PFGE showed that among these patients 96% (50/52) had persistence with the primary infecting E. coli strain and 4% (2/50) had different E. coli strains at the two follow-up visits (both had persistence followed by reinfection). The finding that the majority of UTIs at follow-up are caused by the primary infecting E. coli strain supports the theory of a vaginal and rectal reservoir but could also support the recent discovery that E. coli strains are able to persist in the bladder epithelium despite appropriate antibiotic treatment, constituting a reservoir for recurrent UTI.Urinary tract infection (UTI) is one of the most common bacterial infections of any organ system and accounts for significant morbidity and high medical costs (11, 32). The prevalence is influenced by gender and age-increasing with age and being most common among females except at early infancy (8). One study found that the incidence of symptomatic UTI among sexually active women aged 18 to 40 years was 0.5 to 0.7 per person-year (16). By the age of 24, one-third of the women were found to have had at least one physician-diagnosed UTI requiring antimicrobial treatment (11). The lifetime risk of UTI for women is reported to be in the range of 40 to 60% (11,29). Recurrent UTI (RUTI) is common, i.e., 16 to 40% of women who experience an episode of UTI are reported to develop recurrence (10,13,19,25). One-fourth of all women with a first UTI have been reported to develop a second UTI within 6 months (10), and within 12 months 50% of women have been reported to experience a recurrence (8,19).Considering the high figures for occurrence of RUTI, it is of considerable importance to understand the pathogenesis behind RUTI in order to be able to devise new treatment and preventive strategies in the future.One aspect to consider regarding the pathogenesis of RUTI is whether it is attributable to reinfection with a new strain or relapse with the primary infecting strain.Approximately 80 to 90% of all community-acquired UTIs and more than 30% of nosocomially acquired UTIs are ca...

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Section: Discussionmentioning

confidence: 99%

Pulsed-Field Gel Electrophoresis Typing of Escherichia coli Strains from Samples Collected before and after Pivmecillinam or Placebo Treatment of Uncomplicated Community-Acquired Urinary Tract Infection in Women

et al. 2006

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“…Although it is believed that bladder infection in humans does not involve the bladder wall, previous studies of human bladders indicated a potential intracellular component of UTI (3). Cultures of bladder biopsies taken from women with sterile urine cultures with various urinary tract symptoms revealed the presence of bacteria.…”

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confidence: 90%

Escherichia coli from Urine of Female Patients with Urinary Tract Infections Is Competent for Intracellular Bacterial Community Formation

et al. 2007

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Nearly 50% of women experience at least one urinary tract infection (UTI) in their lifetime. Studies with mice have revealed that uropathogenic Escherichia coli (UPEC) isolates invade superficial umbrella cells that line the bladder, allowing them to find a safe haven and subvert clearance by innate host responses. Rapid intracellular replication results in the formation of distinctive intracellular bacterial communities (IBCs). In this study, we evaluated whether UPEC strains cultured from the urine of women and classified as causing acute cystitis, recurrent cystitis, asymptomatic bacteriuria, or pyelonephritis could progress through the IBC cascade in a well-characterized mouse model of cystitis. Of 18 UPEC isolates collected from women, 15 formed IBCs. Variations in the size, number, and kinetics of IBC formation were observed with strains isolated from women with different clinical syndromes. Two of the three isolates that did not form IBCs when inoculated alone were able to do so when coinoculated with an isolate that was capable of generating IBCs. The mixed infections dramatically altered the behavior of the coinfecting bacteria relative to their behavior in a single infection. The study also showed that mice with five different genetic backgrounds can support IBC formation. Although UPEC isolates differ genetically in their virulence factors, the majority of UPEC isolates from different types of UTI proceed through the IBC pathway, confirming the generality of IBCs in UTI pathogenesis in mice.

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“…12 The tissue was then dried in a critical point dryer (Polaron Equipment) and coated with gold for 2 min in a sputter coater (EM Scope) as previously described. 13 The specimens were examined in a Cambridge S600 stereoscan electronmicroscope.…”

Section: Scanning Electronmicroscopy (Sem)mentioning

confidence: 99%

The pathogenesis of urinary tract infections associated with Escherichia coli, Staphylococcus saprophyticus and S. epidermidis

Mctaggart

Rigby

Elliott

1990

Journal of Medical Microbiology

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Summary.A model was developed in mice to study the pathogenesis of urinary tract infections caused by Staphylococcus saprophyticus strains LM-1 and LM-2, Escherichia coli SP444 and S. epidermidis EOO1. Murine urinary bladders were inoculated with lo8 bacteria via a temporary urinary catheter and samples of urine and bladder were removed at days 1, 3, 5 and 10 after inoculation. They were examined both bacteriologically and by electronmicroscopy. Severe disruption of the urothelium was present immediately and the urothelium had become oedematous and ulcerated with increased urothelial exfoliation. Disruption of the urothelium was similar with all the four pathogens studied. The three strains of coagulase-negative staphylococci preferentially attached to the urothelial cell tight junctions and were not associated with polymorphonuclear leucocytes. In comparison, E. coli SP444 was randomly attached over the entire urothelium and was often in association with macrophages. Phagocytosis of E. coli by superficial urothelial cells also occurred.

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Bacteriology and ultrastructure of the bladder in patients with urinary tract infections

Cited by 86 publications

References 7 publications

Pulsed-Field Gel Electrophoresis Typing of Escherichia coli Strains from Samples Collected before and after Pivmecillinam or Placebo Treatment of Uncomplicated Community-Acquired Urinary Tract Infection in Women

Pulsed-Field Gel Electrophoresis Typing of Escherichia coli Strains from Samples Collected before and after Pivmecillinam or Placebo Treatment of Uncomplicated Community-Acquired Urinary Tract Infection in Women

Escherichia coli from Urine of Female Patients with Urinary Tract Infections Is Competent for Intracellular Bacterial Community Formation

The pathogenesis of urinary tract infections associated with Escherichia coli, Staphylococcus saprophyticus and S. epidermidis

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