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Journal of Clinical Microbiology, May 2006, p. 1776-1781, Vol. 44, No. 5
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.5.1776-1781.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Pulsed-Field Gel Electrophoresis Typing of Escherichia coli Strains from Samples Collected before and after Pivmecillinam or Placebo Treatment of Uncomplicated Community-Acquired Urinary Tract Infection in Women

Karen Ejrnaes,^1* Dorthe Sandvang,¹ Bettina Lundgren,² Sven Ferry,^3,4 Stig Holm,^3,5 Tor Monsen,³ Rolf Lundholm,³ and Niels Frimodt-Moller¹

National Center for Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, Denmark,¹ Department of Clinical Microbiology, Hvidovre, Denmark,² Department of Clinical Microbiology, Umea, Sweden,³ Umea Primary Health Care Centre, Umea, Sweden,⁴ Department of Medical Microbiology and Immunology, University of Gothenburg, Gothenburg, Sweden⁵

Received 20 October 2004/ Returned for modification 8 December 2004/ Accepted 6 March 2006

The primary infecting Escherichia coli strains from 156 women with community-acquired uncomplicated urinary tract infection (UTI) randomized to pivmecillinam or placebo and the E. coli strains causing UTI at two follow-up visits were typed using pulsed-field gel electrophoresis (PFGE). In the pivmecillinam treatment group PFGE showed that among patients having a negative urine culture at the first follow-up 77% (46/60) had a relapse with the primary infecting E. coli strain and 23% (14/60) had reinfection with a new E. coli strain at the second follow-up. Among patients having E. coli at the first follow-up PFGE showed that 80% (32/40) had persistence with the primary infecting E. coli strain, 15% (6/40) had reinfection with a new E. coli strain, and 5% (2/40) had different E. coli strains at the two follow-up visits (one had reinfection followed by relapse, and the other had persistence followed by reinfection). In the placebo group the majority had E. coli at the first follow-up. PFGE showed that among these patients 96% (50/52) had persistence with the primary infecting E. coli strain and 4% (2/50) had different E. coli strains at the two follow-up visits (both had persistence followed by reinfection). The finding that the majority of UTIs at follow-up are caused by the primary infecting E. coli strain supports the theory of a vaginal and rectal reservoir but could also support the recent discovery that E. coli strains are able to persist in the bladder epithelium despite appropriate antibiotic treatment, constituting a reservoir for recurrent UTI.

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* Corresponding author. Mailing address: National Center for Antimicrobials and Infection Control, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark. Phone: 45 32 68 38 37. Fax: 45 32 68 32 31. E-mail: ejr{at}ssi.dk.

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Journal of Clinical Microbiology, May 2006, p. 1776-1781, Vol. 44, No. 5
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.5.1776-1781.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

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