Relationship between Escherichia coli strains causing acute cystitis in women and the fecal E-coli population of the host
Relationship between Escherichia coli strains causing acute cystitis in women and the fecal E-coli population of the host
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DOI：
10.1128/jcm.00813-08
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发表时间：
2008-08-01
影响因子：
9.4
通讯作者：
Prats, Guillem
中科院分区：
文献类型：
--
作者：
Moreno, Eva;Andreu, Antonia;Prats, Guillem
以前的流行病学评估的患病率与特殊致病性假说的尿路感染（UTI）的发病机制，在妇女可能已经混淆了潜在的主机之间的差异与UTI的妇女和健康对照，并没有考虑到克隆复杂性的粪便大肠杆菌人口的主机。在本研究中，42名妇女急性单纯性膀胱炎作为自己的对照分析致病性大肠杆菌。大肠杆菌菌株和并发肠E.大肠杆菌群。通过重复元件PCR和宏观限制性分析评估每个受试者的尿液分离物和30个粪便菌落之间的克隆性。每个独特的克隆进行基于PCR的PCR分型和毒力基因分型。分子分析解析了109个独特的克隆（4个仅尿克隆、38个尿-粪便克隆和67个仅粪便克隆）。尿液克隆表现出比仅粪便克隆显著更高的B2组流行率（69%对10%; P < 0.001）和更高的聚集毒力评分（平均值，6.2对2.9; P < 0.001）。在预测尿液克隆状态的多水平回归模型中，显著的阳性预测因子包括B2组、10个个体毒力性状、总毒力评分、粪便优势、相对粪便丰度和（本研究独有的）少克隆粪便样本。总之，在粪便E.急性膀胱炎、少克隆性、克隆优势、毒力和B2群状态的妇女的大肠杆菌群体紧密交织在一起。系统发育组B2状态和/或相关毒力因子可能促进粪便丰度和少克隆性，从而促进UTI发病机制的上游步骤。这种关系表明，一个可能的和解的患病率和特殊致病性的假设。
Previous epidemiological assessments of the prevalence versus special-pathogenicity hypothesis for urinary tract infection (UTI) pathogenesis in women may have been confounded by underlying host population differences between women with UTI and healthy controls and have not considered the clonal complexity of the fecal Escherichia coli population of the host. In the present study, 42 women with acute uncomplicated cystitis served as their own controls for an analysis of the causative E. coli strain and the concurrent intestinal E. coli population. Clonality among the urine isolate and 30 fecal colonies per subject was assessed by repetitive-element PCR and macrorestriction analysis. Each unique clone underwent PCR-based phylotyping and virulence genotyping. Molecular analysis resolved 109 unique clones (4 urine-only, 38 urine-fecal, and 67 fecal-only clones). Urine clones exhibited a significantly higher prevalence of group B2 than fecal- only clones (69% versus 10%; P < 0.001) and higher aggregate virulence scores (mean, 6.2 versus 2.9; P < 0.001). In multilevel regression models for predicting urine clone status, significant positive predictors included group B2, 10 individual virulence traits, the aggregate virulence score, fecal dominance, relative fecal abundance, and (unique to the present study) a pauciclonal fecal sample. In summary, within the fecal E. coli populations of women with acute cystitis, pauciclonality, clonal dominance, virulence, and group B2 status are closely intertwined. Phylogenetic group B2 status and/or associated virulence factors may promote fecal abundance and pauciclonality, thereby contributing to upstream steps in UTI pathogenesis. This relationship suggests a possible reconciliation of the prevalence and special-pathogenicity hypotheses.