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The primary infectingEscherichia coli strains from 156 women with community-acquired uncomplicated urinary tract infection (UTI) randomized to pivmecillinam or placebo and theE. coli strains causing UTI at two follow-up visits were typed using pulsed-field gel electrophoresis (PFGE). In the pivmecillinam treatment group PFGE showed that among patients having a negative urine culture at the first follow-up 77% (46/60) had a relapse with the primary infectingE. coli strain and 23% (14/60) had reinfection with a newE. coli strain at the second follow-up. Among patients havingE. coli at the first follow-up PFGE showed that 80% (32/40) had persistence with the primary infectingE. coli strain, 15% (6/40) had reinfection with a newE. coli strain, and 5% (2/40) had differentE. coli strains at the two follow-up visits (one had reinfection followed by relapse, and the other had persistence followed by reinfection). In the placebo group the majority hadE. coli at the first follow-up. PFGE showed that among these patients 96% (50/52) had persistence with the primary infectingE. coli strain and 4% (2/50) had differentE. coli strains at the two follow-up visits (both had persistence followed by reinfection). The finding that the majority of UTIs at follow-up are caused by the primary infectingE. coli strain supports the theory of a vaginal and rectal reservoir but could also support the recent discovery thatE. coli strains are able to persist in the bladder epithelium despite appropriate antibiotic treatment, constituting a reservoir for recurrent UTI.

journal of clinical microbiology

Pulsed-Field Gel Electrophoresis Typing of <i>Escherichia coli</i> Strains from Samples Collected before and after Pivmecillinam or Placebo Treatment of Uncomplicated Community-Acquired Urinary Tract Infection in Women

Pulsed-Field Gel Electrophoresis Typing of Escherichia coli Strains from Samples Collected before and after Pivmecillinam or Placebo Treatment of Uncomplicated Community-Acquired Urinary Tract Infection in Women