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Urinary tract infection (UTI) is one of the most frequent bacterial infections worldwide (Weichhart et al., 2008) and a common cause of morbidity, especially in women (Foxman & Brown, 2003). Escherichia coli is the main aetiological agent of UTI (Foxman & Brown, 2003). Despite the frequent recurrence of UTIs caused by E. coli, little is known about the bacterial characteristics associated with recurrent urinary tract infection (RUTI); the pathogenesis is incompletely described and not definitively explained. In the past it was believed that RUTI was primarily due to reinfection with a new strain (Brauner et al., 1992; Foxman et al., 2000). However, since the more widespread application of PFGE typing, the hypothesis of RUTIs being caused by persistence or relapse is now more widely accepted (Ejrnaes et al., 2006; Kõljalg et al., 2009). The terms used in this study for UTI occurring repeatedly, modified from those of Ejrnaes et al. (2006), are as follows: recurrence is used for repeatedly occurring UTI without knowledge of strain similarity; reinfection is used for UTI with a new strain, i.e. a strain different from the primary strain; persistence is used for UTI with the same strain as the primary infecting strain with no known negative culture separating the urine cultures; and relapse is used for UTI with the same strain as the primary infecting strain but with a negative urine culture or a culture different from the primary infecting strain separating the two urine cultures. The aim of the study was to identify and characterize consecutive isolates from cases of RUTI to investigate whether RUTI caused by E. coli is primarily due to persistence or reinfection. We also aimed to generate further knowledge about the characteristics of E. coli associated with RUTI.

Persisting clones of Escherichia coli isolates from recurrent urinary tract infection in men and women