INFECTIONS of the urinary tract with strains of Proteus mirabilis are common and second only to Escherichia coli infections in the frequency with which they occur. However, whereas the majority of E. coli infections are confined to the bladder, Proteus strains have a special predilection for the upper urinary tract where they cause much greater kidney damage than E. coli (Braude, Shapiro and Siemienski, 1959 ;Braude and Siemienski, 1960;Fairley et al., 1971 ;Asscher, 1975).The reservoir of the infecting strain is thought to be the bowel and there has been controversy over many years as to whether the serotypes of the E. coli that are frequently implicated have a special pathogenicity for the urinary tract or simply reflect the predominance of these strains in the gut flora. The recent simple, reliable and highly discriminatory method of typing Proteus by proticine production and sensitivity (P/S typing) (Senior, 1977a) has provided a means of investigating the same problem for the P . mirabilis strains associated with urinary-tract infections. Evidence presented below strongly suggests that particular P/S types of P . mirabilis have a special affinity for the urinary tract.
MATERIALS AND METHODSIsolation of strains from urine. Urine specimens from local general practices and hospitals were received for routine bacteriological examination. Viable counts were done only on freshly voided or refrigerated specimens by plating a standard loopful (i.e. 4 PI) of a well mixed sample on blood agar (Oxoid CM 55 Blood Agar Base and 5 % horse blood) and MacConkey agar (Oxoid CM 7) plates. After overnight incubation at 37"C, six colonies, including representatives of all morphological types of colony, were picked from those plates showing significant, i.e., more than 400 colonies, pure growths of organisms thought to be strains of Proteus species, and inoculated into Tryptone Water (Oxoid CM 87) and incubated at 37°C for 3-6 h. The cultures were subsequently inoculated on to two blood-agar plates as previously described (Senior, 19776) to test simultaneously the Dienes compatibility of all six isolates from each urine specimen in all combinations. After overnight incubation at 37°C the plates were examined for Dienes lines by reflected light. Tryptone-water cultures of each representative Dienes type found and every non-swarming isolate were inoculated into urea