Positive effects of local therapy with a vaginal lactic acid gel on dysuria and E.coli bacteriuria question our current views on recurrent cystitis

Abstract

Objective We tested the effect of vaginally applied lactic acid gel on symptoms and bacteriuria in acutely exacerbated recurrent Eschericia coli cystitis. Methods Carnoy fixed samples of the morning urine from 20 women with a history of recurrent E.coli cystitis were prospectively investigated for bacteriuria using fluorescence in situ hybridization (FISH). Results In 11/20 women with acute cystitis, the symptoms and bacteriuria were regressive with lactic acid gel treatment, without the need for antibiotic treatment. The complete regression of symptoms took between 1 week (7 women) and 4 weeks (4 women). In parallel with this regression, the microscopic shape of E.coli bacteria in these women changed from short rods to long curly filaments starting within the first days of therapy. The filamentous transformation affected 100% of the E.coli population in six women and at least 50% of E.coli population in five women and was not observed in urine samples from untreated women or in women without clinical response to lactic acid gel. This could not happen if the bladder was the origin of the infection. Conclusions A number of recurrent and probably acute cystitis is a local vagino-urethritis caused by an adhesive invasive E.coli biofilm of the vaginal surface.

Vaginal treatment with lactic acid gel delays relapses in recurrent urinary tract infections: results from an open, multicentre observational study

“…[30] Lactic acid was also shown to be a strong outer membrane disintegrating as well as permeabilising agent of gram-negative bacteria [31]. Swidsinski et al [16] have demonstrated a positive effect of a vaginal lactic acid gel on acute E. coli cystitis.…”

Infección de vías urinarias no complicada en mujeres

“…38 Esas bacterias producen ácido láctico a partir de la fermentación del glicógeno producido por las células epiteliales dependientes de estrógenos, manteniendo el pH ácido de la vagina, protegiendo la microbiota vaginal, previniendo las disbiosis y evitando la adherencia de uropatógenos incluido la E. coli que generan infección. [39][40][41] En contraste, las mujeres postmenopáusicas presentan cambios relacionados con la disminución de los niveles hormonales tanto de andrógenos como de estrógenos. Lo anterior resulta en atrofia del epitelio vaginal, llevando a la disminución en la concentración de Lactobacillus spp y a su vez, una menor producción de ácido láctico que aumenta el pH vaginal, lo que crea un ambiente más propicio para la sobreinfección del tejido urogenital.…”

The role of bacterial biofilms in the development of chronic pathological processes in the vagina and endometrium

“…P. Watnick и R. Kolter (2000) называют биопленки «городом микро-бов» [23]. Следует отметить, что увеличение ве-роятности формирования биопленки связано с увеличением количества условно-патогенных микроорганизмов в среде до 10 × 6 кое/мл [24].…”

“…69 СТАТЬИ к клеткам вагинального эпителия в концентра-циях 10 × 5-6 [24]. При этом бактерии приоб-рели нитчатую «колониальную» форму, чему приписывается их резистентность к бета-лак-тамным антибиотикам.…”