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Journal of Clinical Microbiology, August 2008, p. 2529-2534, Vol. 46, No. 8
0095-1137/08/$08.00+0     doi:10.1128/JCM.00813-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Relationship between Escherichia coli Strains Causing Acute Cystitis in Women and the Fecal E. coli Population of the Host{triangledown}

Eva Moreno,1 Antonia Andreu,1 Carles Pigrau,2 Michael A. Kuskowski,3 James R. Johnson,3 and Guillem Prats1*

Departments of Microbiology,1 Infectious Diseases, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain,2 Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota 554173

Received 29 April 2008/ Accepted 5 May 2008

Previous epidemiological assessments of the prevalence versus special-pathogenicity hypothesis for urinary tract infection (UTI) pathogenesis in women may have been confounded by underlying host population differences between women with UTI and healthy controls and have not considered the clonal complexity of the fecal Escherichia coli population of the host. In the present study, 42 women with acute uncomplicated cystitis served as their own controls for an analysis of the causative E. coli strain and the concurrent intestinal E. coli population. Clonality among the urine isolate and 30 fecal colonies per subject was assessed by repetitive-element PCR and macrorestriction analysis. Each unique clone underwent PCR-based phylotyping and virulence genotyping. Molecular analysis resolved 109 unique clones (4 urine-only, 38 urine-fecal, and 67 fecal-only clones). Urine clones exhibited a significantly higher prevalence of group B2 than fecal-only clones (69% versus 10%; P < 0.001) and higher aggregate virulence scores (mean, 6.2 versus 2.9; P < 0.001). In multilevel regression models for predicting urine clone status, significant positive predictors included group B2, 10 individual virulence traits, the aggregate virulence score, fecal dominance, relative fecal abundance, and (unique to the present study) a pauciclonal fecal sample. In summary, within the fecal E. coli populations of women with acute cystitis, pauciclonality, clonal dominance, virulence, and group B2 status are closely intertwined. Phylogenetic group B2 status and/or associated virulence factors may promote fecal abundance and pauciclonality, thereby contributing to upstream steps in UTI pathogenesis. This relationship suggests a possible reconciliation of the prevalence and special-pathogenicity hypotheses.

* Corresponding author. Mailing address: Microbiology Department, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. Phone: (34) 93 274 68 52. Fax: (34) 93 274 68 01. E-mail: gprats{at}vhebron.net

{triangledown} Published ahead of print on 21 May 2008.

Journal of Clinical Microbiology, August 2008, p. 2529-2534, Vol. 46, No. 8
0095-1137/08/$08.00+0     doi:10.1128/JCM.00813-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.





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