title: Cellulose and PapG are important for Escherichia coli causing recurrent urinary tract infection in women.
abstract: OBJECTIVE
  To identify Escherichia coli factors associated with bacterial persistence in the human urogenital tract using well-defined clinical isolates from women with cystitis.
  
  
  METHODS
  E. coli were isolated from women suffering from recurrent cystitis. For comparison, isolates from sporadically infected patients and healthy volunteers were included in the analysis. Samples were taken on three occasions from the urine, periurethra, and vagina. Isolates were typed by pulsed-field gel electrophoresis, and virulence factors were detected by PCR and morphotypic analysis.
  
  
  RESULTS
  In all patients, the original E. coli strain was isolated repeatedly and from different regions. The presence of papG coding for a P fimbriae subtype linked to pyelonephritis was associated with strains isolated from patients with recurrent cystitis, including both among urinary and vaginal isolates. The biofilm component cellulose was detected at a higher frequency in urinary isolates from recurrent versus sporadic cystitis.
  
  
  CONCLUSIONS
  The hypothesis of a periurethral/vaginal E. coli reservoir is supported by the results of this study. Our results also indicate an impact of cellulose on E. coli persistence in the human urogenital tract.
authors: Division of Clinical Microbiology, Department of Microbiology, Tumor and Cell Biology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors: B S
authors: BS
authors: Norinder
authors: P
authors: P
authors: Lüthje
authors: M
authors: M
authors: Yadav
authors: L
authors: L
authors: Kadas
authors: H
authors: H
authors: Fang
authors: C E
authors: CE
authors: Nord
authors: A
authors: A
authors: Brauner
mesh_terms: D018830:Adhesins, Escherichia coli / Q000378:metabolism*; D000328:Adult; D002482:Cellulose / Q000378:metabolism*; D016000:Cluster Analysis; D016521:Electrophoresis, Gel, Pulsed-Field; D004926:Escherichia coli / Q000145:classification / Q000302:isolation & purification / Q000378:metabolism / Q000472:pathogenicity*; D004927:Escherichia coli Infections / Q000382:microbiology*; D005260:Female; D036781:Fimbriae Proteins / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D058889:Molecular Typing; D016133:Polymerase Chain Reaction; D012008:Recurrence; D014521:Urethra / Q000382:microbiology; D014552:Urinary Tract Infections / Q000382:microbiology*; D014556:Urine / Q000382:microbiology; D014621:Vagina / Q000382:microbiology; D037521:Virulence Factors / Q000235:genetics
chemical_list: D018830:Adhesins, Escherichia coli; C092426:PapG protein, E coli; D037521:Virulence Factors; D036781:Fimbriae Proteins; D002482:Cellulose