The Periurethral Aerobic Flora in Girls Highly Susceptible to Urinary Infections

Abstract

After the age of 5 years, normal children have but few aerobic gram-negative rods periurethrally. This study examines whether there is an abnormal periurethral colonization in urinary tract infection-prone girls during infection-free intervals, indicating a defective local defence. In 13 girls with a history of recurrent infection, daily bacterial samples were obtained from the periurethral area and from urine. Sampling continued until an infection eventually occurred. Seven girls contracted a urinary tract infection within 3-30 days. All were heavy colonized with gram-negative rods, often several species, before infection appeared. Serotyping of E. coli confirmed that it was the colonizing strain which later invaded the bladder. The findings suggest a local defect in the antibacterial defence of infection-prone individuals and gives strong evidence for ascending infection. Six girls remained uninfected during an observation period of 9-123 days. They all had a normal periurethral flora. A reasonable hypothesis would be that the same factor counteracted colonization and infection. Since abnormal periurethral colonization was not a constant phenomenon the postulated defect may vary. This might explain the fact that urinary tract infections often appear in quick succession, often followed by long infection-free intervals.

Escherichia coliin extra-intestinal infections

“…The infecting E. coli type can often be isolated from the faeces before or at onset of symptomatic UTI (Griineberg, Leigh & Brumfitt, 1968;Lidin-Janson et al 1977), and it has furthermore been shown that colonization of the vaginal introitus and the periurethral area precedes the infection (Cooke & Ewins, 1975;Bollgren & Winberg, 1976;Fowler & Stamey, 1977).…”

Pharmacodynamic evaluation of ofloxacin and trimethoprim-sulfamethoxazole in vaginal fluid of women treated for acute cystitis

“…Although the healthy vagina is infrequently colonized by members of the family Enterobacteriaceae, colonization of the vaginal introitus with E. coli usually precedes acute cystitis (2,7,13 for only a few antibiotics (4,5,11,14). Moreover, the influence of the new fluorinated quinolone antibiotics, such as ofloxacin, on vaginal colonization with E. coli has not been previously reported.…”

“…Vaginal colonization with Escherichia coli is an integral first step in the pathogenesis of acute cystitis, and persistent vaginal colonization with E. coli has been associated with the development of recurrent urinary infections in women (2,7,13). However, few studies have examined the pharmacodynamic properties of antibiotics in vaginal fluid or their effect on vaginal E. coli colonization.…”

“…For the ofloxacin-treated women, eradication of vaginal E. col was aated with a hig ratio of drug concentration in vaginal fluid to that in serum. We conclude that ofloxacin and TMP both achieve hig concentrations in vaginal fluid and are equaHly successful in eradicating E. coil from the vagina.Vaginal colonization with Escherichia coli is an integral first step in the pathogenesis of acute cystitis, and persistent vaginal colonization with E. coli has been associated with the development of recurrent urinary infections in women (2,7,13 Vaginal fluid was obtained by using a sterile preweighed 25-mm-diameter filter paper disk (no. 42; Whatman, Inc., Clifton, N.J.) that was stored in a sealed test tube.…”

“…Vaginal colonization with Escherichia coli is an integral first step in the pathogenesis of acute cystitis, and persistent vaginal colonization with E. coli has been associated with the development of recurrent urinary infections in women (2,7,13 Vaginal fluid was obtained by using a sterile preweighed 25-mm-diameter filter paper disk (no. 42; Whatman, Inc., Clifton, N.J.) that was stored in a sealed test tube.…”