Julien Coussement1,2, Maria Angeles Argudín1, Amélie Heinrichs1, Judith Racapé3,4, Ricardo de Mendonça1, Louise Nienhaus1, Alain Le Moine4, Sandrine Roisin1, Magali Dodémont1, Frédérique Jacobs2, Daniel Abramowicz5, Brian D Johnston6, James R Johnson6, Olivier Denis1,7. 1. Department of Microbiology, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. 2. Division of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. 3. Research Center "Biostatistiques, Epidémiologie et Recherche Clinique", École de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium. 4. Department of Nephrology, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. 5. Department of Nephrology-Hypertension, Universitair Ziekenhuis Antwerpen, Antwerp University, Antwerpen, Belgium. 6. Minneapolis Veterans Health Care System, Minneapolis, MN, USA. 7. École de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
Abstract
BACKGROUND: Urinary tract infection is the most common infection among kidney transplant recipients (KTRs). Many transplant physicians fear that host compromise will allow low-virulence strains to cause pyelonephritis in KTRs, so they often treat asymptomatic bacteriuria with antibiotics. Identification of the host/microbe factors that determine the clinical presentation (i.e. pyelonephritis versus asymptomatic bacteriuria) once an Escherichia coli strain enters a KTRs bladder could inform management decisions. METHODS: We prospectively collected all E. coli isolates causing either pyelonephritis or asymptomatic bacteriuria in KTRs at our institution (December 2012-June 2015). Whole-genome sequencing was used to assess bacterial characteristics (carriage of 48 virulence genes and phylogenetic and clonal background). Host parameters were also collected. RESULTS: We analysed 72 bacteriuria episodes in 54 KTRs (53 pyelonephritis, 19 asymptomatic bacteriuria). The pyelonephritis and asymptomatic bacteriuria isolates exhibited a similar total virulence gene count per isolate [median 18 (range 5-33) and 18 (5-30), respectively; P = 0.57] and for individual virulence genes differed significantly only for the prevalence of the pap operon (pyelonephritis 39%,versus asymptomatic bacteriuria 0%; P = 0.002). No other significant between-group differences were apparent for 86 other bacterial and host variables. CONCLUSIONS: Our findings suggest that bacterial adherence plays a role in the pathogenesis of pyelonephritis in KTRs despite significantly altered host urinary tract anatomy and weakened immunity. Whether KTRs might benefit from targeted therapies (e.g. vaccination or inhibitors of fimbrial adhesion) has yet to be studied.
BACKGROUND: Urinary tract infection is the most common infection among kidney transplant recipients (KTRs). Many transplant physicians fear that host compromise will allow low-virulence strains to cause pyelonephritis in KTRs, so they often treat asymptomatic bacteriuria with antibiotics. Identification of the host/microbe factors that determine the clinical presentation (i.e. pyelonephritis versus asymptomatic bacteriuria) once an Escherichia coli strain enters a KTRs bladder could inform management decisions. METHODS: We prospectively collected all E. coli isolates causing either pyelonephritis or asymptomatic bacteriuria in KTRs at our institution (December 2012-June 2015). Whole-genome sequencing was used to assess bacterial characteristics (carriage of 48 virulence genes and phylogenetic and clonal background). Host parameters were also collected. RESULTS: We analysed 72 bacteriuria episodes in 54 KTRs (53 pyelonephritis, 19 asymptomatic bacteriuria). The pyelonephritis and asymptomatic bacteriuria isolates exhibited a similar total virulence gene count per isolate [median 18 (range 5-33) and 18 (5-30), respectively; P = 0.57] and for individual virulence genes differed significantly only for the prevalence of the pap operon (pyelonephritis 39%,versus asymptomatic bacteriuria 0%; P = 0.002). No other significant between-group differences were apparent for 86 other bacterial and host variables. CONCLUSIONS: Our findings suggest that bacterial adherence plays a role in the pathogenesis of pyelonephritis in KTRs despite significantly altered host urinary tract anatomy and weakened immunity. Whether KTRs might benefit from targeted therapies (e.g. vaccination or inhibitors of fimbrial adhesion) has yet to be studied.
Authors: Michael Biggel; Basil B Xavier; James R Johnson; Karen L Nielsen; Niels Frimodt-Møller; Veerle Matheeussen; Herman Goossens; Pieter Moons; Sandra Van Puyvelde Journal: Nat Commun Date: 2020-11-24 Impact factor: 14.919
Authors: David Hernández-Hernández; Bárbara Padilla-Fernández; María Yanira Ortega-González; David Manuel Castro-Díaz Journal: Curr Bladder Dysfunct Rep Date: 2021-12-01