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Prospective cohort study of microbial and inflammatory events immediately preceding Escherichia coli recurrent urinary tract infection in women.
Title | Prospective cohort study of microbial and inflammatory events immediately preceding Escherichia coli recurrent urinary tract infection in women. |
Publication Type | Journal Article |
Year of Publication | 2009 |
Authors | Czaja, CA, Stamm, WE, Stapleton, AE, Roberts, PL, Hawn, TR, Scholes, D, Samadpour, M, Hultgren, SJ, Hooton, TM |
Journal | J Infect Dis |
Volume | 200 |
Issue | 4 |
Pagination | 528-36 |
Date Published | 2009 Aug 15 |
ISSN | 0022-1899 |
Keywords | Adolescent, Adult, Cohort Studies, Escherichia coli Infections, Female, Humans, Inflammation, Middle Aged, Recurrence, Risk Factors, Specimen Handling, Urinary Tract Infections, Young Adult |
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. |
DOI | 10.1086/600385 |
Alternate Journal | J. Infect. Dis. |
PubMed ID | 19586416 |