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Intracellular bacteria may be related to recurrent UTI
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The presence of intracellular bacteria in urine may explain the high proportion of children with recurrent urinary tract infections, according to study findings in Clinical Infectious Diseases.
Luciana Robino, PhD, of the Universidad de la República in Montevideo, Uruguay, and colleagues analyzed urine samples from 133 children who presented to a pediatric hospital with a UTI caused by Escherichia coli. The mean age of the children was 4 years.
The most common symptom was fever, accounting for 67.6% of patients. Twenty-seven percent of patients had low UTIs. Approximately 38% of patients had at least one previous UTI, and seven patients had double excretory tract or vesicoureteral reflux.
Regarding E. coli strains, 102 (76.6%) belonged to B2-D phylogenetic groups. Of these, 59 belonged to group D and 43 to group B2. Twenty-three strains (17.2%) were in group A and eight in group B1 (6%).
Approximately 80% of strains were considered uropathogenic E. coli based on detection of two or more virulence factors after screening. Of the 27 non-uropathogenic strains, 11 were in phylogenetic group D, eight were in group A, six were in group B and two were in group B2.
Intracellular bacteria was detected in 36.8% of urine samples after optical microscopic analysis. Of these, 30 of 49 were intracellular bacteria communities and 19 were isolated intracellular bacteria. Twenty-one of the 49 intracellular bacteria exhibited filamentous bacteria.
The presence of intracellular bacteria was significantly associated with recurrent UTI (OR=3.3; 95% CI, 1.3-9). Patients who did not present morphological or functional disorders of the urinary tract had a higher risk for recurrent UTI (OR=8; 95% CI, 2.3-27.4). Formation of intracellular bacteria communities was significantly associated with lower UTIs (OR=3.6; 95% CI, 1.1-11.8). Intracellular bacteria was not associated with clinical symptoms.
“Most pediatric UTI therapeutic guidelines recommend the use of beta-lactamics for empirical treatments. However, these antibiotics reach low intracellular concentrations, so it would be necessary to provide an alternative therapeutic plan in patients with recurrent UTI without anatomical or functional urinary tract pathology in which [intracellular bacteria] or [intracellular bacteria communities] may be involved,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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