Keegan S J, Graham C, Neal D E, Blum-Oehler G, N'Dow J, Pearson J P, Gally D L
Department of Microbiology and Immunology, University of Newcastle upon Tyne and Freeman Hospital, Newcastle upon Tyne, United Kingdom.
J Urol. 2003 Jun;169(6):2382-7. doi: 10.1097/01.ju.0000067445.83715.7b.
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.
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.
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 (alpha-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.
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.
将肠段移植到泌尿道会增加泌尿道感染的易感性。我们对这些患者的细菌感染进行了特征分析，并检测了大肠杆菌分离株的毒力基因型和持续性。
我们追踪了26例接受使用移植肠段进行膀胱重建手术的患者。对从这些患者尿液中分离出的大肠杆菌菌株进行基因型分析，以确定其既定的毒力决定因素，并将其携带频率与从社区获得性泌尿道感染中分离出的大肠杆菌菌株以及匿名志愿者的粪便菌群进行比较。还使用脉冲场凝胶电泳对9例患者的大肠杆菌菌株进行了纵向研究。
大肠杆菌是最常分离出的细菌，占单一细菌感染的59%（105例中的62例）。分离出的其他细菌包括克雷伯菌属、变形杆菌属和粪肠球菌。与粪便菌株相比，社区获得性大肠杆菌菌株更有可能携带特定黏附素（P菌毛和S菌毛）和毒素（α-溶血素和细胞毒性坏死因子）的多种决定因素。膀胱重建菌株的携带频率处于中间水平，且无显著差异。关键发现是大肠杆菌菌株会长期持续存在，在某些患者中长达2年，尽管进行了各种抗菌治疗。
本研究强调必须采取进一步措施来预防和治疗这一易感人群的泌尿道感染。应特别关注持续性感染的治疗。
