Prospective cohort study of microbial and inflammatory events immediately preceding Escherichia coli recurrent 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.

• Authors: C A Czaja, W E Stamm, A E Stapleton, P L Roberts, T R Hawn, D Scholes, M Samadpour, S J Hultgren, T M Hooton
• Journal: The Journal of infectious diseases (J Infect Dis) Vol. 200 Issue 4 Pg. 528-36 (Aug 15 2009) ISSN: 0022-1899 [Print] United States
• PMID: 19586416 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Topics

• Adolescent
• Adult
• Cohort Studies
• Escherichia coli Infections (microbiology)
• Female
• Humans
• Inflammation (complications)
• Middle Aged
• Recurrence
• Risk Factors
• Specimen Handling
• Urinary Tract Infections (microbiology)
• Young Adult