TY - JOUR
T1 - Prospective cohort study of microbial and inflammatory events immediately preceding escherichia coli recurrent urinary tract infection in women
AU - Czaja, C. A.
AU - Stamm, W. E.
AU - Stapleton, A. E.
AU - Roberts, P. L.
AU - Hawn, T. R.
AU - Scholes, D.
AU - Samadpour, M.
AU - Hultgren, S. J.
AU - Hooton, T. M.
N1 - Funding Information:
Financial support: National Institutes of Health (Specialized Centers of Research grant P50 AR 049475 and National Institute of Diabetes and Digestive and Kidney Diseases grant P01 DK 53369).
PY - 2009/8/15
Y1 - 2009/8/15
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=69149091826&partnerID=8YFLogxK
U2 - 10.1086/600385
DO - 10.1086/600385
M3 - Article
C2 - 19586416
AN - SCOPUS:69149091826
SN - 0022-1899
VL - 200
SP - 528
EP - 536
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 4
ER -