title: 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: Department of Medicine, University of Washington, Seattle, Washington, USA. czajac@njhealth.org
authors: C A
authors: CA
authors: Czaja
authors: W E
authors: WE
authors: Stamm
authors: A E
authors: AE
authors: Stapleton
authors: P L
authors: PL
authors: Roberts
authors: T R
authors: TR
authors: Hawn
authors: D
authors: D
authors: Scholes
authors: M
authors: M
authors: Samadpour
authors: S J
authors: SJ
authors: Hultgren
authors: T M
authors: TM
authors: Hooton
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004927:Escherichia coli Infections / Q000382:microbiology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications*; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D013048:Specimen Handling; D014552:Urinary Tract Infections / Q000382:microbiology*; D055815:Young Adult