Skip to main content
SpringerLink
Log in

Rezidivierende Harnweginfektionen der Frau

Erregervirulenz und Wirtsreaktion

Recurrent urinary tract infections in women

Virulence of pathogens and host reaction

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Die Interaktionen von wirtsspezifischen und mikrobiologischen Faktoren sind für rezidivierende Harnweginfektionen (rHWI) verantwortlich. Die anatomischen Verhältnisse des weiblichen Urogenitaltraktes begünstigen die Besiedelung durch uropathogene Erreger. Lokale Faktoren wie die Glukosekonzentration im Urin, die Stabilität der Laktobazillenpopulation, der Einfluss von Östrogenen, die Aktivität des Tamm-Horsefall-Proteins oder von Defensinen und Störungen systemischer Abwehrmechanismen bestimmen den Verlauf einer Erkrankung.

Der wichtigste uropathogene Erreger ist Escherichia coli. Dieser exprimiert verschiedene Virulenzfaktoren zu denen Adhäsine, Toxine, Eisenaufnahmesysteme und eine Kapsel gehören. Ungeklärt ist bisher, ob bestimmte Virulenzfaktoren für E.-coli-Stämme, die rHWI verursachen, charakteristisch sind. Die intrazelluläre Reservoirbildung durch Invasion von Uroepithelzellen könnte eine weitere bisher zuwenig beachtete Ursache für rHWI sein. Daher sollte die Anwendung von auch intrazellulär wirksamen Antibiotika bei rHWI erwogen werden.

Abstract

The interactions of host-specific and microbial factors are responsible for recurrent urinary tract infections (rUTI). The anatomical properties of the female urogenital tract favor colonization by uropathogens. Local factors such as glucose concentration of the urine, stability of the lactobacilli population, the influence of estrogens, the activity of Tamm-Horsfall protein or of defensins, and disturbance of the systemic defense mechanisms dictate the course of an infection.

The most prominent uropathogen is E. coli. It expresses various virulence factors including adhesions, toxins, iron uptake systems, and a capsule. It is still unclear if there are virulence factors characteristic for E. coli strains causing rUTI. The formation of intracellular reservoirs by invasion of uroepithelial cells by E. coli could be another, as yet little noticed cause for rUTI. Therefore, in cases of rUTI the application of intracellularly active antibiotics should be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Anderson M, Bollinger D, Hagler A, Hartwell H, Rivers B, Ward K, Steck TR (2004) Viable but nonculturable bacteria are present in mouse and human urine specimens. J Clin Microbiol 42: 753–758

    Article  PubMed  Google Scholar 

  2. Arthur M, Johnson CE, Rubin RH et al. (1989) Molecular epidemiology of adhesin and hemolysin virulence factors among uropathogenic Escherichia coli. Infect Immun 57: 303–313

    PubMed  Google Scholar 

  3. Bates JM, Raffi HM, Prasadan K (2004) Tamm-Horsefall protein knockout mice are more prone to urinary tract infection: rapid communication. Kidney Int 65: 791–797

    Article  PubMed  Google Scholar 

  4. Bouckaert J, Berglund J, Schembri M et al. (2005) Receptor binding studies disclose a novel class of high-affinity inhibitors of the Escherichia coli FimH adhesin. Mol Microbiol 55: 441–455

    Article  PubMed  Google Scholar 

  5. Bower JM, Eto DS, Mulvey MA (2005) Covert operations of uropathogenic Escherichia coli within the urinary tract. Traffic 6: 18–31

    Article  PubMed  Google Scholar 

  6. Chambers ST, Lever M (1996) Betaines and urinary tract infections. Nephron 74: 1–10

    PubMed  Google Scholar 

  7. Fasth A, Hanson LA, Jodal U, Peterson H (1979) Autoantibodies to Tamm-Horsfall protein association with urinary tract infections in girls. J Pediatr 95: 50–54

    Google Scholar 

  8. Finer G, Landan D (2004) Pathogenesis of urinary tract infections with normal female antomy. Lancet Infect Dis 4: 631–635

    Article  PubMed  Google Scholar 

  9. Foxman B, Zhang L, Tallman P, Palin K, Rode C, Bloch C, Gillespie B, Marrs CF (1995) Virulence characteristics of Escherichia coli causing first urinary tract infection predict risk of second infection. J Infect Dis 172: 1536–1541

    PubMed  Google Scholar 

  10. Fünfstück R, Smith JW, Tschäpe H, Stein G (1997) Pathogenetic aspects of uncomplicated urinary tract infection: recent advances. Clin Nephrol 47: 13–18

    PubMed  Google Scholar 

  11. Fünfstück R, Stein G (2002) Harnwegsinfektionen bei Diabetes mellitus. Spectr Diabetes 4: 7–13

    Google Scholar 

  12. Geerlings SE, Brouwer EC, Gaastra W, Verhoef J, Hoepelmann AJM (1999) Effects of glucose and pH on uropathogenic and non-uropathogenic Escherichia coli studies with urine from diabetic and non-diabetic individuals. J Med Microbiol 48: 535–539

    PubMed  Google Scholar 

  13. Goluszko P, Moseley SL, Truong LD et al. (1997) Development of experimental model of chronic pyelonephritis with Escherichia coli O75:K5:H-bearing Dr fimbriae. J Clin Invest 99: 1662–1672

    PubMed  Google Scholar 

  14. Goluszko P, Goluszko E, Nowicki G, Nowicki S, Popov V, Wang H-Q (2005) Vaccination with purified Dr fimbriae reduces mortality associated with chronic urinary tract infection due to Escherichia coli bearing Dr adhesion. Infect Immun 73: 627–631

    Article  PubMed  Google Scholar 

  15. Hiratuska T, Nakazato M, Shimizu A et al. (2000) Structural analysis of human β-defensin-1 and its significance in urinary tract infection. Nephron 85: 35–4

    Google Scholar 

  16. Johnson JR, Johnson CE, Maslow JN (1999) Clinical and bacteriological correlates of the papG alleles among Escherichia coli strains from children with acute cystitis. Pediatr Infect Dis J 18: 446–451

    Article  PubMed  Google Scholar 

  17. Johnson JR, O‘Bryan TT, Delavari P, Kuskowski M, Stapleton A, Carlino U, Russo TA (2001) Clonal relationships and extended virulence genotypes among Escherichia coli isolates from women with a first or recurrent episode of cystitis. J Infect Dis 183: 1508–1517

    Article  PubMed  Google Scholar 

  18. Karkkainen UM, Ikaheimo R, Katila MJ, Siitonen A (2000) Recurrence of urinary tract infections in adult patients with community-acquired pyelonephritis caused by E. coli: a 1-year follow-up. Scand J Infect Dis 32: 495–499

    Article  PubMed  Google Scholar 

  19. Kreft B, Jabs WJ, Laskay T (2002) Polarized expression of Tamm-Horesefall protein by renal tubular epithelial cells activates human granulocytes. Infect Immun 70: 2650–2656

    Article  PubMed  Google Scholar 

  20. Kokot F, Dulawa J (2000) Tamm-Horsefall-Protein updated. Nephron 85: 97–102

    Article  PubMed  Google Scholar 

  21. Kunin CM (1997) Urinary tract infection. Williams & Williams, Baltimore, pp 337–338

  22. Langermann S, Mollby R, Burlein JE et al. (2000) Vaccination with FimH adhesin protects cynomolgus monkeys from colonization and infection by uropathogenic Escherichia coli. J Infect Dis 181: 774–778

    Article  PubMed  Google Scholar 

  23. Oelschlaeger TA, Dobrindt U, Hacker J (2002) Pathogenicity islands of uropathogenic E. coli and the evolution of virulence. Int J Antimicrob Agents 19: 517–521

    Article  PubMed  Google Scholar 

  24. Oelschlaeger TA, Friedrich A (2002) Antibiotika gegen Erreger von Harnwegsinfektionen: extra- und intrazelluläre Wirksamkeit. Gynäkol Nachricht 3: 10

    Google Scholar 

  25. Rakita RM (1998) Intracellular activity, potential clinical uses of antibiotics. ASM News 64: 570–575

    Google Scholar 

  26. Reinhart HH, Obedeann N, Robinson N (1990) Urinary excretion of Tamm-Horsfall-protein in woman with recurrent urinary tract infection. J Urol 144: 1185–1187

    PubMed  Google Scholar 

  27. Säemann MD, Weichhart T, Zeyda M (2005) Tamm-Horsefall glycoprotein links innate immune cell activation with adaptive immunity via a Toll-like receptor-4-dependent mechanism. J Clin Invest 115: 468–475

    Article  PubMed  Google Scholar 

  28. Schilling JD, Lorenz RG, Hultgren SJ (2002) Effect of trimethoprim-sulamethoxazole on recurrent bacteriuria and bacterial persistence in mice infected with uropathogenic Escherichia coli. Infect Immun 70: 7042–7049

    Article  PubMed  Google Scholar 

  29. Schnapp D, Reid CJ, Harris A (1998) Localisation of expression of human beta defensin-1 in the pancreas and kidney. J Pathol 189: 99–103

    Article  Google Scholar 

  30. Serafini-Cessi F, Malagonini N, Cavallone D (2003) Tamm-Horsfall Glykoprotein: Biology and clinical relevance. Am J Kid Dis 42: 658–676

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Klinik für Innere Medizin I, Sophien- und Hufeland-Klinikum, Weimar

    R. Fünfstück

  2. Institut für Molekulare Infektionsbiologie, Universität, Röntgenring 11, 97070, Würzburg

    T. A. Oelschlaeger

Authors
  1. T. A. Oelschlaeger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Fünfstück
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. A. Oelschlaeger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oelschlaeger, T.A., Fünfstück, R. Rezidivierende Harnweginfektionen der Frau. Urologe 45, 412–420 (2006). https://doi.org/10.1007/s00120-006-1020-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-006-1020-z

Schlüsselwörter

Keywords

Search

Navigation