Mitsumori K, Terai A, Yamamoto S, Yoshida O
Department of Urology, Faculty of Medicine, Kyoto University, Japan.
J Urol. 1997 Dec;158(6):2329-32. doi: 10.1016/s0022-5347(01)68244-2.
Previous studies indicated that acute pyelonephritis in infants is initiated by the dominance of uropathogenic strains in fecal flora. Such pathogenic evidence, however, is still lacking for adult women. In this study, the validity of a fecal-perineal-urethral hypothesis in acute uncomplicated pyelonephritis of adult women was assessed at a genetic level.
A total of 1,200 Escherichia coli isolates from the urine and rectal swab of 12 adult women with acute uncomplicated pyelonephritis were examined. The clonality of the urinary and fecal isolates was evaluated by genotyping of 6 urovirulence determinants and pulsed-field gel electrophoresis. Furthermore, urovirulence genotypes were examined in E. coli isolates from the rectal swab of 30 normal healthy women (mean 26.7 isolates per person).
The E. coli strains causing pyelonephritis were present in the rectal swab in 10 of 12 patients and were a predominant fecal clone in 9 cases. Also, P-fimbriated strains dominated in the fecal flora in 10 of 30 normal healthy women.
The clonal identity of the urinary and fecal strains in acute pyelonephritis clearly supports the fecal-perineal-urethral hypothesis.
先前的研究表明，婴儿急性肾盂肾炎是由尿路致病性菌株在粪便菌群中占优势引发的。然而，成年女性中仍缺乏此类致病证据。在本研究中，在基因水平评估了粪便-会阴-尿道假说在成年女性急性单纯性肾盂肾炎中的有效性。
对12例成年急性单纯性肾盂肾炎女性患者的尿液和直肠拭子中的1200株大肠杆菌分离株进行检测。通过对6种尿路毒力决定因素进行基因分型和脉冲场凝胶电泳，评估尿液和粪便分离株的克隆性。此外，还对30名正常健康女性直肠拭子中的大肠杆菌分离株进行了尿路毒力基因型检测（平均每人26.7株分离株）。
12例患者中有10例直肠拭子中存在引起肾盂肾炎的大肠杆菌菌株，其中9例为主要的粪便克隆株。此外，30名正常健康女性中有10名的粪便菌群中P菌毛菌株占优势。
急性肾盂肾炎中尿液和粪便菌株的克隆一致性明确支持粪便-会阴-尿道假说。
