title: In vitro analysis of the bactericidal activity of Escherichia coli Nissle 1917 against pediatric uropathogens.
abstract: OBJECTIVE
  The usefulness of prophylactic antibiotics to prevent recurrent urinary tract infections in children was recently questioned. Some groups have attempted to use probiotics, most commonly lactobacillus, to prevent recurrent infections by altering the intestinal bacterial reservoir with variable results. Mutaflor® is a possible alternative probiotic in which the active agent is Nissle 1917. Nissle 1917 is a commensal Escherichia coli strain that eradicates pathogenic bacteria from the gastrointestinal tract. Due to its ability to alter the intestinal biome we hypothesized that Mutaflor may have the potential to prevent recurrent urinary tract infections. Thus, we used an in vitro assay to analyze the effectiveness of Nissle 1917 for eradicating pediatric uropathogens.
  
  
  METHODS
  We established a collection of 43 bacterial pediatric uropathogens. With each isolate a microcin-type assay was performed to determine the effectiveness of Nissle 1917 on bacterial growth inhibition and competitive overgrowth.
  
  
  RESULTS
  Nissle 1917 adversely affected the growth of 34 of the 43 isolates (79%) isolates. It inhibited the growth of 21 isolates and overgrew 13. The percent of species adversely affected by Nissle 1917 was 40% for Pseudomonas, 50% for E. coli, Enterococcus and Staphylococcus, 100% for Klebsiella and Enterobacter, and 0% for Citrobacter and Serratia.
  
  
  CONCLUSIONS
  Nissle 1917, the active agent in Mutaflor, inhibited or out competed most bacterial isolates. These mechanisms could be used in vivo to eradicate uropathogens from the gastrointestinal tract. Further study is needed to determine whether Mutaflor can prevent recurrent urinary tract infections in children.
authors.affiliation: Department of Urology, Naval Medical Center, San Diego, California 92134-5000, USA. douglas.storm@med.navy.mil
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Storm
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Koff
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Horvath
authors.forename: Birong
authors.initials: B
authors.lastname: Li
authors.forename: Sheryl S
authors.initials: SS
authors.lastname: Justice
mesh_terms: D002648:Child; D002675:Child, Preschool; D015169:Colony Count, Microbial; D004926:Escherichia coli / Q000254:growth & development* / Q000302:isolation & purification; D041981:Gastrointestinal Tract / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019936:Probiotics / Q000494:pharmacology*; D055502:Secondary Prevention; D014551:Urinary Tract / Q000382:microbiology; D014552:Urinary Tract Infections / Q000382:microbiology / Q000517:prevention & control*