Adherence of uropathogenic Escherichia coli to host tissue is required for infection and is mediated by fimbriae, such as pyelonephritis-associated pili (Pap). Expression of P fimbriae is regulated by phase variation, and to date, phase transition frequencies have been measured only for pap regulatory region constructs integrated into the E. coli K-12 chromosome. The aim of this work was to measure P phase transition frequencies in clinical isolates for the first time, including frequencies for the sequenced strain E. coli CFT073. P fimbriation and associated phase transition frequencies were measured for two E. coli clinical isolates and compared with levels for homologous pap constructs in E. coli K-12. Fimbriation and off-to-on transition frequencies were always higher in the clinical isolate. It was concluded that the regulatory inputs controlling papI expression are likely to be different in E. coli CFT073 and E. coli K-12 as (i) phase variation could be stimulated in E. coli K-12 by induction of papI and (ii) the level of expression of a papI::gfp ؉ fusion was higher in E. coli CFT073 than in E. coli K-12. Furthermore, phase transition frequencies for the two E. coli CFT073 pap clusters were shown to be different depending on the culture conditions, indicating that there is a hierarchy of expression depending on signal inputs.Urinary tract infections (UTIs) are some of the most common human bacterial infections and are estimated to affect 150 million people worldwide and to cost more than $6 billion annually in direct health care expenditures. These infections include asymptomatic bacteriuria, cystitis, and acute pyelonephritis. The latter presents with severe clinical symptoms and can result in renal scarring and renal failure in children (53). Uropathogenic Escherichia coli (UPEC) is the leading cause of UTIs and is responsible for up to 80% of uncomplicated cases and more than 30% of nosocomial infections (8). The initial colonization and persistence of E. coli in the urinary tract require coordinated expression of multiple virulence factors, including fimbriae, iron acquisition systems, and toxins. Fimbrial adhesins promote colonization by binding to specific receptors on the surface of host cells. The type 1 fimbrial adhesin, FimH, binds ␣-D-mannose-containing receptors abundant in the bladder (11), and PapG, the P fimbria tip adhesin, recognizes kidney glycosphingolipids containing the Gal-␣(1-4)-Gal moiety (26-28). Epidemiological studies have established that there is a strong link between P fimbriae and pyelonephritis (3,37), and recent studies have demonstrated that P fimbriae can trigger proinflammatory cascades in the human urinary tract (42, 51). P fimbriae are encoded by the pyelonephritis-associated pilus (pap) operon that contains the structural genes papA, -E, -F, -G, and -H, the usher gene papC, the periplasmic chaperone gene papD, and genes encoding two regulators, papB and papI (4, 45). UPEC isolates associated with symptomatic disease are more likely to contain multiple P fimbria oper...