Mobley H L, Chippendale G R, Tenney J H, Hull R A, Warren J W
Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore 21201.
J Clin Microbiol. 1987 Dec;25(12):2253-7. doi: 10.1128/jcm.25.12.2253-2257.1987.
Long-term urinary catheterization results in polymicrobial bacteriuria and is complicated by fever, bacteremia, acute pyelonephritis, and death. Escherichia coli is a common urine isolate from catheterized patients and can persist for months. We hypothesized that fimbria-mediated adherence contributes to its persistence. For 1 year, urine specimens were collected from 51 patients greater than or equal to 65 years of age who were catheterized for greater than or equal to 30 days. E. coli was isolated at greater than or equal to 10(5) CFU/ml from 447 (36%) of 1,230 weekly urine specimens from 26 patients. Week 1 isolates from 52 definable episodes were tested for hemagglutination, hybridization with gene sequences from the pil and pap operons, in vitro adherence to catheter material, binding of 125I-labeled Tamm-Horsfall protein, hemolysin and colicin V production, and serum resistance. The proportions of isolates of short (1 week only), medium (2 to 11 weeks) and long (greater than or equal to 12 weeks) episodes of bacteriuria which expressed type 1 fimbriae as assayed by mannose-sensitive hemagglutination were 59, 65, and 92%, respectively. Isolates with the pil operon (the genome for type 1 fimbriae) from episodes lasting greater than 1 week expressed mannose-sensitive hemagglutination more frequently (P = 0.011) than pil-positive isolates from episodes of less than or equal to 1 week. Isolates from episodes of greater than 1 week also bound significantly more Tamm-Horsfall protein than isolates from episodes of less than or equal to 1 week (P = 0.044). Although nearly half of the isolates produced P fimbriae, an important virulence factor for the development of pyelonephritis, no correlation with persistence could be made. Overall, the E. coli isolates expressed traits similar to those of strains that caused cystitis. Type 1 fimbriae appear to be important for the persistence of E. coli in the long-term-catheterized urinary tract.
长期留置导尿管会导致多种微生物性菌尿，并伴有发热、菌血症、急性肾盂肾炎和死亡等并发症。大肠杆菌是导尿患者尿液中常见的分离菌，且可持续存在数月。我们推测菌毛介导的黏附作用有助于其持续存在。在1年的时间里，从51名年龄大于或等于65岁、导尿时间大于或等于30天的患者中收集尿液标本。在26名患者的1230份每周尿液标本中，有447份（36%）分离出的大肠杆菌菌落形成单位数大于或等于10⁵CFU/ml。对52次可明确的菌尿发作第1周分离出的菌株进行了血凝试验、与菌毛和菌毛相关操纵子基因序列的杂交试验、体外对导管材料的黏附试验、¹²⁵I标记的Tamm-Horsfall蛋白的结合试验、溶血素和大肠菌素V产生试验以及血清抗性试验。通过甘露糖敏感血凝试验检测，菌尿发作时间短（仅1周）、中（2至11周）和长（大于或等于12周）的菌株中表达1型菌毛的比例分别为59%、65%和92%。菌尿发作持续时间大于1周的菌株中含有菌毛操纵子（1型菌毛的基因组）的菌株比发作时间小于或等于1周的菌毛阳性菌株更频繁地表达甘露糖敏感血凝（P = 0.011）。菌尿发作持续时间大于1周的菌株与发作时间小于或等于1周的菌株相比，结合Tamm-Horsfall蛋白的能力也显著更强（P = 0.044）。虽然近一半的分离菌株产生P菌毛，这是肾盂肾炎发生的一种重要毒力因子，但无法确定其与持续存在之间的相关性。总体而言，大肠杆菌分离菌株表现出与引起膀胱炎的菌株相似的特性。1型菌毛似乎对长期导尿的尿路中大肠杆菌的持续存在很重要。
