Escherichia coli Causing Recurrent Urinary Tract Infections: Comparison to Non-Recurrent Isolates and Genomic Adaptation in Recurrent Infections

Abstract

Recurrent urinary tract infection (rUTI) remains a major problem for many women and therefore the pursuit for genomic and phenotypic traits which could define rUTI has been ongoing. The present study applied a genomic approach to investigate recurrent urinary tract infections by comparative analyses of recurrent and non-recurrent Escherichia coli isolates from general practice. From whole-genome sequencing data, phylogenetic clustering and genomic traits were studied on a collection of isolates which caused recurrent infection compared to non-recurrent isolates. In addition, genomic variation between the 1st and following infection was studied on a subset of the isolates. Evidence of limited adaptation between the recurrent infections based on single nucleotide polymorphism analyses with a range of 0–13 non-synonymous single nucleotide polymorphisms (SNPs) between the paired isolates. This included an overrepresentation of SNPs in metabolism genes. We identified several genes which were more common in rUTI isolates, including nine fimbrial genes, however, not significantly after false-discovery rate. Finally, the results show that recurrent isolates of the present dataset are not distinctive by variation in the core genome, and thus, did not cluster distinct from non-rUTI isolates in a SNP phylogeny.

Recurrent E. coli Urinary Tract Infections in Nursing Homes: Insight in Sequence Types and Antibiotic Resistance Patterns

“…The sequence types ST131 and ST73 were most commonly found which is in line with previous data [ 6 , 36 ] and we found comparable E. coli sequence types in nursing home residents with a single UTI and rUTI (see Supplementary File Table S1 ) [ 11 ].…”

“…The genetic characteristics of E. coli colonizing the intestine in relation to rUTI were previously studied among (younger) adults [ 9 , 11 , 12 , 13 ]. Chen et al, characterized E. coli strains from stool and urine specimens from women with rUTI, between 18 and 41 years old.…”

“…It was found that uropathogens were simultaneously present in the urine and the intestine according to clonal tracking, implicating a different potential hypothesis for uropathogen persistence in rUTI (e.g., reinfection of urinary tract from an external source or bacterial persistence within urinary tract) [ 13 ]. No distinctive variation was found in the core genome of E. coli causing rUTI compared to E. coli in non-rUTI based on single nucleotide polymorphism analyses (SNP-analyses) [ 11 ]. The current knowledge about the genetics of E. coli causing rUTI is mostly based on research in adults instead of older adults (aged ≥ 65 years).…”

Adherence to European Association of Urology Guidelines and State of the Art of Glycosaminoglycan Therapy for the Management of Urinary Tract Infections: A Narrative Review and Expert Meeting Report

“…The available scientific evidence supports the efficacy and safety of HA + CS in the management of rUTIs. It is known that rUTIs are, for the vast majority of cases, the recurrence of infection caused by E. coli [52] , [53] , while there are no data on the effectiveness of GAG therapy in the management of rUTIs caused by different bacterial species. The therapy improves patients’ QoL and decreases the number of episodes of UTIs, allowing a more rational use of antibiotics.…”

Application of pharmacokinetic/pharmacodynamic concepts to the development of treatment regimens for sporadic canine urinary tract infections: Challenges and paths forward

“…As described by Murray et al (2021), a number of hypotheses exist regarding the mechanisms responsible for rUTIs. Although there appear to be factors that can contribute to this recurrence, at least with regard to uropathogenic E. coli (UPEC), strains associated with sporadic versus rUTIs appear to be genetically and phenotypically indistinguishable (Nielsen et al, 2021). Nevertheless, antimicrobial use presents an important factor affecting incidence of rUTI either because of insufficient or prolonged drug exposure.…”