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Pathogenesis of urinary tract infection —experimental studies of vaginal resistance to colonization

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Abstract

The review summarizes studies of vaginal colonization resistance againstEscherichia coli in a primate model. The genital flora surrounding the urethral orifice exerts a strong colonization resistance. Amoxicillin profoundly disturbs the normal vaginal microflora, reduces its adherence to vaginal epithelial cells in vivo and promotes a persistent vaginalE. coli colonization. Certain cephalosporins may have a similar effect. The induced ecological changes mimic those seen in patients with recurrent urinary tract infections (UTI). Amoxicillin also promotes the spread ofE. coli from rectum to vagina, which may be of clinical significance. Trimethoprim and nitrofurantoin do not have these effects. The natural colonization resistance could not clearly be correlated with the presence of lactobacilli, which were only transiently reduced by amoxicillin. The colonization resistance againstE. coli could only partly be restored by vaginal instillation of lactobacilli, but was fully restored by flushing of the whole vaginal flora from a healthy monkey. Clinical observations suggest that accumulation ofE. coli around the urethral orifice increases the risk of UTI. We conclude that antibiotics and other compounds that interfere with the normal genital flora may increase the risk of UTI. This should influence the choice of antibiotics in the treatment of UTI.

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References

  1. Herthelius BM, Hedström K-G, Möllby R, Nord CE, Pettersson L, Winberg J (1988) Pathogenesis of urinary tract infections — amoxicillin induces genitalEscherichia coli colonization. Infection 16: 263–266

    Google Scholar 

  2. Scheinfeld J, Schaeffer AJ, Cordon-Cardo C, Rogatko A, Fair WR (1989) Association of the Lewis blood-group phenotype with recurrent urinary tract infections in women. N Engl J Med 320: 773–777

    Google Scholar 

  3. Stamm WE, McKevitt M, Roberts PL, White NJ (1991) Natural history of recurrent urinary tract infections in women. Rev Infect Dis 131: 261–266

    Google Scholar 

  4. Bollgren I, Winberg J (1976) The periurethral aerobic bacterial flora in girls highly susceptible to urinary infections. Acta Paediatr Scand 65: 81–87

    Google Scholar 

  5. Mackowiak PA (1982) The normal microbial flora. N Engl J Med 307: 83–93

    Google Scholar 

  6. Van der Waij D (1983) The colonization resistance of the digestive tract. In: Gruneberg RN (ed) Antibiotic choice: the importance of colonization resistance. Research Studies Press, Letchworth, pp 7–31

    Google Scholar 

  7. Florey HW (1946) The use of micro-organisms for therapeutic purposes. Yale J Biol Med 19: 101–118

    Google Scholar 

  8. Bibel DJ (1982) Bacterial interference, bacteriotherapy and bacterioprophylaxis. In: Aly R, Shinefield HR (eds) Bacterial interference. CRC, Boca Raton, pp 1–12

    Google Scholar 

  9. Nord CE, Heimdahl A, Kager L (1986) Antimicrobial induced alterations of human oropharyngeal and intestinal microflora. Scand J Infect Dis [Suppl] 49: 64–72

    Google Scholar 

  10. Aronsson B, Möllby R, Nord CE (1985) Antimicrobial agents andClostridium difficile in acute enteric disease: epidemiological data from Sweden 1980–82. J Infect Dis 151: 476–481

    Google Scholar 

  11. Herthelius M, Gorbach SL, Möllby R, Nord CE, Pettersson L, Winberg J (1989) Elimination of vaginal colonization withE. coli by administration of indigenous flora. Infect Immun 57: 2447–2451

    Google Scholar 

  12. Herthelius M, Möllby R, Nord C-E, Winberg J (1989) Amoxicillin promotes vaginal colonization with adheringEscherichia coli present in feces. Pediatr Nephrol 3: 443–447

    Google Scholar 

  13. Herthelius-Elman M, Möllby R, Nord CE, Winberg J (1992) Lack of effect of trimethoprim and nitrofurantoin on colonization resistance in the vagina of monkeys. Infection 20: 105–110

    Google Scholar 

  14. Herthelius-Elman M, Möllby R, Nord CE, Winberg J (1992) The effect of amoxycillin on vaginal colonization resistance and normal vaginal flora in monkeys. J Antimicrob Chemother 29: 329–340

    Google Scholar 

  15. Herthelius-Elman M (1991) Vaginal ecology and uropathogenicE. coli. Importance of the normal flora and effects of antibiotics on colonization resistance. Academic Thesis Karolinska Institute, Stockholm, ISBN 91-628-0410-3

    Google Scholar 

  16. Roberts JA, Kaack B, Källenius G, Möllby R, Winberg J, Svenson SB (1984) Receptors for pyelonephritogenicEscherichia coli in primates. J Urol 131: 163–168

    Google Scholar 

  17. Tullus K, Hörlin K, Svenson SB, Källenius B (1984) Epidemic outbreaks of acute pyelonephritis caused by nosocomial spread of P-fimbriatedEscherichia coli in children. J Infect Dis 150: 728–736

    Google Scholar 

  18. Roberts JA, Kaack MB, Fusell EN (1989) Bacterial adherence in urinary tract infections: preliminary studies in a primate model. Infection 17: 401–404

    Google Scholar 

  19. Roberts JA, Clayton JD, Seibold HR (1972) The natural incidence of pyelonephritis in the nonhuman primate. Invest Urol 9: 276–281

    Google Scholar 

  20. Sjöberg I, Håkansson S, Holm SE (1990) Accumulation of penicillin in vaginal fluid. Obstet Gynecol 75: 18–21

    Google Scholar 

  21. Stamey TA, Condy M (1975) The diffusion and concentration of trimethoprim in human vaginal fluid. J Infect Dis 131: 261–266

    Google Scholar 

  22. Lidefelt KJ, Bollgren I, Nord CE (1991) Changes in periurethral microflora after antimicrobial drugs. Arch Dis Child 66: 683–685

    Google Scholar 

  23. Mårild S, Jodal U, Mangelius L (1989) Medical history among children with acute pyelonephritis compared to controls. Pediatr Infect Dis J 8: 511–515

    Google Scholar 

  24. Winberg J, Andersen HJ, Bergström T, Jacobsson B, Larson H, Lincoln K (1974) Epidemiology of symptomatic urinary tract infection in childhood. Acta Paediatr Scand [Suppl] 252: 1–20

    Google Scholar 

  25. Bollgren I, Winberg J (1976) The periurethral aerobic flora in healthy boys and girls. Acta Paediatr Scand 65: 74–80

    Google Scholar 

  26. Wiswell TE, Smith FR, Bass JW (1985) Decreased incidence of urinary tract infections in circumcised male infants. Pediatrcis 75: 901–903

    Google Scholar 

  27. Klebanoff SJ (1992) Effects of the spermicidal agent nonoxynol-9 on vaginal microflora. J Infect Dis 165: 19–25

    Google Scholar 

  28. Hooton TM, Hillier S, Johnson C, Roberts PL, Stamm WE (1991)Escherichia coli bacteriuria and contraceptive method. JAMA 265: 64–69

    Google Scholar 

  29. Redondo-Lopez V, Cook RL, Sobel JD (1990) Emerging role of lactobacilli in the control and maintenance of the vaginal bacterial microflora. Rev Infect Dis 12: 856–872

    Google Scholar 

  30. Reid G, Cook RL, Bruce AW (1987) Examination of strains of lactobacilli for properties that may influence bacterial interference in the urinary tract. J Urol 138: 330–335

    Google Scholar 

  31. Roos K, Grahn E, Lind L, Holm S (1989) Treatment of recurrent streptococcal tonsillitis by recolonization with alpha-streptococci. Eur J Clin Microbiol Infect Dis 8: 318–319

    Google Scholar 

  32. Schwan A, Sjölin S, Trottestam U, Aronsson B (1984) RelapsingClostridium difficile enterocolitis cured by rectal infusion of normal faeces. Scand J Infect Dis 16: 211–215

    Google Scholar 

  33. Bruce AW, Reid G (1988) Intravaginal instillation of lactobacilli for prevention of recurrent urinary tract infections. Can J Microbiol 34: 339–343

    Google Scholar 

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Authors and Affiliations

  1. The Karolinska Institute, Department of Paediatrics, Karolinska Hospital, 10 401, Stockholm, Sweden

    Jan Winberg & Maria Herthelius-Elman

  2. The Karolinska Institute, Department of Bacteriology, Karolinska Hospital, Stockholm, Sweden

    Roland Möllby

  3. Department of Microbiology, Huddinge Hospital, Stockholm

    Carl Erik Nord

  4. Department of Bacteriology, National Bacteriological Laboratory, Stockholm, Sweden

    Maria Herthelius-Elman, Roland Möllby & Carl Erik Nord

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  1. Jan Winberg
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  2. Maria Herthelius-Elman
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  3. Roland Möllby
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  4. Carl Erik Nord
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Winberg, J., Herthelius-Elman, M., Möllby, R. et al. Pathogenesis of urinary tract infection —experimental studies of vaginal resistance to colonization. Pediatr Nephrol 7, 509–514 (1993). https://doi.org/10.1007/BF00852528

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  • DOI: https://doi.org/10.1007/BF00852528

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