Elevated urine IL-10 concentrations associate with Escherichia coli persistence in older patients susceptible to recurrent urinary tract infections

Abstract

Background Age is a significant risk factor for recurrent urinary tract (rUTI) infections, but the clinical picture is often confused in older patients who also present with asymptomatic bacteriuria (ASB). Yet, how bacteriuria establishes in such patients and the factors underpinning and/or driving symptomatic UTI episodes are still not understood. To explore this further a pilot study was completed in which 30 male and female community based older patients (mean age 75y) presenting clinically with ASB / rUTIs and 15 control volunteers (72y) were recruited and monitored for up to 6 months. During this period symptomatic UTI episodes were recorded and urines collected for urinary cytokine and uropathogenic Escherichia coli (UPEC) analyses. Results Eighty-six per cent of patients carried E. coli (10 2 ≥ 10 5 CFU/ml urine) at some point throughout the study and molecular typing identified 26 different E. coli strains in total. Analyses of urine samples for ten different cytokines identified substantial patient variability. However, when examined longitudinally the pro-inflammatory markers, IL-1 and IL-8, and the anti-inflammatory markers, IL-5 and IL-10, were significantly different in the patient urines compared to those of the controls ( P < 0.0001). Furthermore, analysing the cytokine data of the rUTI susceptible cohort in relation to E. coli carriage, showed the mean IL-10 concentration to be significantly elevated ( P = 0.04), in patients displaying E. coli numbers ≥10 5 CFU/ml. Conclusions These pilot study data suggest that bacteriuria, characteristic of older rUTI patients, is associated with an immune homeostasis in the urinary tract involving the synthesis and activities of the pro and anti-inflammatory cytokines IL-1, IL-5, IL-8 and IL-10. Data also suggests a role for IL-10 in regulating bacterial persistence.

Clinical Remission Using Personalized Low-Dose Intravenous Infusions of N-acetylcysteine with Minimal Toxicities for Interstitial Cystitis/Bladder Pain Syndrome

“…Once her UTI symptoms were resolved, IL-10 expression showed a dramatic decrease ( Figure 2 c). Collectively, these studies and our findings support the pro-inflammatory characteristics and increased expression of IL-10 in inflammatory environments [ 32 , 33 , 34 , 35 , 36 ].…”

“…This is consistent with the findings in our patient who demonstrated increased levels of IL-10, which correlated with increased levels of IL-8 and TNF-α; these levels decreased when IL-10 expression decreased. Additional studies have revealed that IL-10 is significantly elevated in patients with UTIs [ 35 , 36 ]. Our findings are consistent, since, at the time of our patient’s UTI at the beginning of treatment ( Figure 1 ), she had the highest levels of IL-10 ( Figure 2 c).…”

Multidrug-resistant Uro-associated Escherichia coli Populations and Recurrent Urinary Tract Infections in Patients Performing Clean Intermittent Self-catheterisation

“…The Achtman MLST scheme was used to type the sequenced AnTIC E. coli isolates [18] . PCR-based typing of strains was performed as previously described [19] .…”

Laboratory markers of urinary tract infection in children: current state and prospects

“…Было показано значимое увеличение концентрации ИЛ-6 и ИЛ-8 у пациентов с ИМП по сравнению с пациентами с ББУ (р < 0,0001). Анализ данных также показал, что у пациентов с рецидивирующей ИМП, у которых отмечалось носительство E. coli, была повышена концентрация противовоспалительного цитокина ИЛ-10 в моче (р = 0,04), что позволило сделать вывод о роли ИЛ-10 в регуляции бактериальной персистенции [39].…”