Prospective Cohort Study of Microbial and Inflammatory Events Immediately PrecedingEscherichia coliRecurrent Urinary Tract Infection in Women

Abstract

Background A prospective cohort study was conducted to characterize the temporal sequence of microbial and inflammatory events immediately preceding Escherichia coli recurrent urinary tract infection (rUTI). Methods Women with acute cystitis and a history of UTI within the previous year self-collected periurethral and urine samples daily and recorded measurements of urine leukocyte esterase, symptoms, and sexual intercourse daily for 3 months. rUTI strains were characterized by pulsed-field gel electrophoresis and genomic virulence profiling. Urinary cytokine levels were measured. Results There were 38 E. coli rUTIs in 29 of 104 women. The prevalence of periurethral rUTI strain carriage increased from 46% to 90% during the 14 days immediately preceding rUTI, with similar increases in same-strain bacteriuria (from 7% to 69%), leukocyte esterase (from 31% to 64%), and symptoms (from 3% to 43%), most notably 2–3 days before rUTI (P < .05 for all comparisons). Intercourse with periurethral carriage of the rUTI strain also increased before rUTI (P = .008). Recurrent UTIs preceded by bacteriuria, pyuria, and symptoms were caused by strains less likely to have P fimbriae than other rUTI strains (P = .002). Conclusions Among women with frequent rUTIs, the prevalences of periurethral rUTI strain carriage, bacteriuria, pyuria, and intercourse dramatically increase over the days preceding rUTI. A better understanding of the pathogenesis of rUTI will lead to better prevention strategies.

Antibiotic susceptibility of microbiota members Escherichia coli strains isolated from stool samples of patients attended Kırıkkale Yüksek İhtisas Hospital in ten months

“…In several studies that shown whether particularly the fecal flora members are UTI factor or not (9,10). Uropathogenic E. coli isolates are located phylogenetically in group B2 and less frequently in the group D. However non-pathogen E. coli isolates are often in group A and B1 and often have less virulence factors.…”

The type 1 pili regulator gene fimX and pathogenicity island PAI-X as molecular markers of uropathogenic Escherichia coli

“…Bacterial strains were routinely cultured in Luria-Bertani broth without antibiotics. Isolates were derived from four sources: (1) well-characterized, published representative pathogenic and commensal strains (n59); (2) isolates collected in previously published clinical studies in Seattle, representing various clinical syndromes of urinary tract infection (n5155) (Czaja et al, 2009;Garofalo et al, 2007;Hooton et al, 1996;Johnson et al, 1987Johnson et al, , 1988Johnson et al, , 1991 as well as control faecal-commensal isolates (n520) (Stapleton et al, 1991); (3) strains from the E. coli reference (ECOR) collection (n568) (Ochman & Selander, 1984) and (4) clinical enterohaemorrhagic E. coli (EHEC) isolates (n57).…”

“…The study population for all studies was non-pregnant, outpatient women ages 18 to 49 seen in the Hall Health Primary Care Center (student health clinic) at the University of Washington (Czaja et al, 2009;Garofalo et al, 2007;Hooton et al, 1996) or Group Health Cooperative of Puget Sound (Garofalo et al, 2007;Hooton et al, 1996), except for isolates collected from in-patients hospitalized with pyelonephritis and/or urosepsis. Pyelonephritis isolates were collected from 20 women ages 18 to 45 hospitalized in one of four hospitals in Seattle (Johnson et al, 1991) and 2 were out-patients (Garofalo et al, 2007).…”

“…Syndromes were defined as follows: acute, uncomplicated cystitis (n568 isolates) was defined as the presence of typical symptoms (dysuria, frequency and/or urgency), and a midstream urine culture containing ¢10 2 c.f.u. bacteria ml 21 (Czaja et al, 2009;Garofalo et al, 2007;Hooton et al, 1996); asymptomatic bacteriuria (ASB; n545) was defined as a midstream urine culture containing .10 5 c.f.u. bacteria ml 21 documented twice at least 24 h apart in a subject with no typical symptoms of UTI (Garofalo et al, 2007;Hooton et al, 1996); acute uncomplicated pyelonephritis (n522) was defined as costovertebral angle pain and/or tenderness, pyuria and bacteriuria with ¢10 4 c.f.u.…”

Population structure and uropathogenic virulence-associated genes of faecal Escherichia coli from healthy young and elderly adults

“…Other factors also increase a woman's likelihood of infection, including sexual activity, oral contraceptives, oestrogen deficiency, diabetes, obstructing lesions and genetic factors such as blood group secretor status (Harrington & Hooton, 2000;Scholes et al, 2000). Among the causative agents of UTI, Escherichia coli is responsible for .90 % of cases and is almost always found amongst the faecal flora of the same host, although these bacteria may be harboured in the vagina or periurethra (Czaja et al, 2009;Moreno et al, 2008).…”