Hemolytic Escherichia coli strains in the human fecal flora as potential urinary pathogens.

Hemolysin production is presumed to be a virulence factor in extraintestinal, e.g. urinary tract, infections caused by Escherichia coli. In order to investigate its incidence among the fecal flora, particularly in combination with other presumptive virulence factors, 369 and 373 fecal isolates from Würzburg, FRG and Lima, Peru respectively were examined. 12% of the former and 4% of the latter were hemolytic (Hly+) compared to 33% of 249 E. coli strains isolated from urinary tract infections in Würzburg. In comparison to those which were non hemolytic (Hly-), Hly+ fecal E. coli isolates were associated to a far greater extent with other factors implicated in urinary tract virulence. 41% of these Hly+ strains (cf. 8% Hly-) possessed mannose resistant hemagglutination (MRHA types V, VI, VII). In addition they belonged to the "common O serogroups" O1, O2, O4, O6, O7, O8, O18, O25, O75 in 61% of cases (cf. 25% Hly-) and they possessed K5 antigen in 13% of instances (cf. 2.5% Hly-). The occurrence of these three virulence factors among Hly+ fecal E. coli strains is very similar to that observed among E. coli urinary isolates. One may conclude that these Hly+ fecal strains constitute a "pool" of potential urinary tract pathogens.