Characterization of Escherichia coli strains causing urinary tract infections in patients with transposed intestinal segments.
OBJECTIVE
Transposition of intestinal segments into the urinary tract predisposes to urinary tract infections. We characterized bacterial infections in these patients and examined the virulence genotype and persistence of Escherichia coli isolates.


METHODS
We followed 26 patients who underwent bladder reconstructive surgery using transposed intestinal segments. E. coli strains isolated from the urine of these patients were genotyped for established virulence determinants and the frequency of carriage was compared with E. coli strains isolated from community acquired urinary infections and the fecal flora of anonymous volunteers. A longitudinal study of E. coli strains in 9 patients was also done using pulsed field gel electrophoresis.


RESULTS
E. coli was the most frequently isolated organism, responsible for 59% (62 of 105) of monobacterial infections. Other bacteria isolated included Klebsiella species, Proteus species and Enterococcus faecalis. Community acquired E. coli strains were more likely to carry multiple determinants for particular adhesins (P and S fimbriae) and toxins (alpha-hemolysin and cytotoxic necrotizing factor) than fecal strains. Carriage frequency for bladder reconstruction strains was intermediary and not significantly different. The key finding was that E. coli strains persisted for prolonged periods, including 2 years in certain patients, often despite various antimicrobial treatments.


CONCLUSIONS
This study highlights that further steps must be taken to prevent and treat urinary tract infections in this susceptible group. Particular attention should be given to the treatment of persistent infections.
Keegan
S J
SJ
Department of Microbiology and Immunology, University of Newcastle upon Tyne and Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Graham
C
C
Neal
D E
DE
Blum-Oehler
G
G
N'Dow
J
J
Pearson
J P
JP
Gally
D L
DL
D000328:Adult; D000368:Aged; D001437:Bacteriuria / Q000382:microbiology; D002353:Carrier State / Q000382:microbiology; D016521:Electrophoresis, Gel, Pulsed-Field; D004926:Escherichia coli / Q000145:classification* / Q000235:genetics; D004927:Escherichia coli Infections / Q000382:microbiology*; D005243:Feces / Q000382:microbiology; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012008:Recurrence; D016476:Urinary Reservoirs, Continent / Q000382:microbiology*; D014552:Urinary Tract Infections / Q000382:microbiology*; D037521:Virulence Factors / Q000235:genetics
D037521:Virulence Factors