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Purpose:

Transposition of intestinal segments into the urinary tract predisposes to urinary tract infections. We characterized bacterial infections in these patients and examined the virulence genotype and persistence of Escherichia coli isolates.

Materials and Methods:

We followed 26 patients who underwent bladder reconstructive surgery using transposed intestinal segments. E. coli strains isolated from the urine of these patients were genotyped for established virulence determinants and the frequency of carriage was compared with E. coli strains isolated from community acquired urinary infections and the fecal flora of anonymous volunteers. A longitudinal study of E. coli strains in 9 patients was also done using pulsed field gel electrophoresis.

Results:

E. coli was the most frequently isolated organism, responsible for 59% (62 of 105) of monobacterial infections. Other bacteria isolated included Klebsiella species, Proteus species and Enterococcus faecalis. Community acquired E. coli strains were more likely to carry multiple determinants for particular adhesins (P and S fimbriae) and toxins (α-hemolysin and cytotoxic necrotizing factor) than fecal strains. Carriage frequency for bladder reconstruction strains was intermediary and not significantly different. The key finding was that E. coli strains persisted for prolonged periods, including 2 years in certain patients, often despite various antimicrobial treatments.

Conclusions:

This study highlights that further steps must be taken to prevent and treat urinary tract infections in this susceptible group. Particular attention should be given to the treatment of persistent infections.

References

  • 1 : Metabolic complications of urinary intestinal diversion. J Urol1992; 147: 1199. LinkGoogle Scholar
  • 2 : Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urol1972; 107: 458. AbstractGoogle Scholar
  • 3 : Secreto-motor function of intestinal segments used in lower urinary tract reconstruction. Br J Urol1987; 60: 532. Google Scholar
  • 4 : Reducing mucus production after urinary reconstruction: a prospective randomized trial. J Urol2001; 165: 1433. AbstractGoogle Scholar
  • 5 : Rupture of ileal neobladder due to urethral obstruction by mucous plug. J Urol1990; 144: 740. LinkGoogle Scholar
  • 6 : Localization of bacteriuria in patients with enterocytosplasty and nonrefluxing conduits. J Urol1987; 138: 1104. AbstractGoogle Scholar
  • 7 : Techniques for urinary undiversion. In: Bladder Reconstruction and Continent Urinary Diversion. Edited by . Chicago: Year Book Medical Publishers1987: 101. Google Scholar
  • 8 : Urinary undiversion: indications, technique and results in 50 cases. J Urol1986; 136: 13. LinkGoogle Scholar
  • 9 : Lower urinary tract reconstruction using stomach and the artificial sphincter. J Urol1993; 149: 1107. LinkGoogle Scholar
  • 10 : The physiology of gastrocystoplasty: once a stomach, always a stomach. J Urol1995; 153: 1977. LinkGoogle Scholar
  • 11 : Urinary pH and urea concentration correlate to the bacterial colonization rate in gastric, colonic, ileal and myoperitoneal bladder augmentation. J Urol1995; 154: 899. LinkGoogle Scholar
  • 12 : Relative microbial resistance of gastric, ileal and cecal bladder augmentation in the rat. J Urol1995; 154: 1895. LinkGoogle Scholar
  • 13 : The significance of the difference in bacterial adherence between bladder and ileum using rat ileal augmented bladder. J Urol1999; 162: 243. LinkGoogle Scholar
  • 14 : Bacterial adherence in a rat bladder augmentation model: ileocystoplasty versus colocystoplasty. J Urol2000; 164: 2104. LinkGoogle Scholar
  • 15 : Mucin gene expression in human urothelium and in intestinal segments transposed into the urinary tract. J Urol2000; 164: 1398. AbstractGoogle Scholar
  • 16 : Clean and sterile intermittent catheterization methods in hospitalized patients with spinal cord injury. Arch Phys Med Rehabil1992; 73: 798. Google Scholar
  • 17 : Virulence factors in Escherichia coli urinary tract infection. Clin Microbiol Rev1991; 4: 80. Google Scholar
  • 18 : Establishment of a persistent Escherichia coli reservoir during the acute phase of a bladder infection. Infect Immun2001; 69: 4572. Google Scholar
  • 19 : Virulence characteristics of Escherichia coli causing first urinary tract infection predict risk of second infection. J Infect Dis1995; 172: 1536. Google Scholar
  • 20 : Detection system for Escherichia coli-specific virulence genes: absence of virulence determinants in B and C strains. Appl Environ Microbiol1997; 63: 703. Google Scholar

From the Departments of Microbiology and Immunology, Surgery and Physiology, University of Newcastle upon Tyne and Department of Microbiology, Freeman Hospital, Newcastle upon Tyne, Academic Urology Unit, Medical School, Aberdeen University, Aberdeen and Zoonotic and Animal Pathogens Research Laboratory, Medical Microbiology, University of Edinburgh, Edinburgh, United Kingdom, and Institute for Molecular Biology of Infectious Diseases, University of Wurzburg, Wurzburg, Germany

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