Virulence determinants of uropathogenic Escherichia coli and Proteus mirabilis.

The urinary tract is among the most common sites of bacterial infection and E. coli is by far the most common infecting agent. In patients with urinary catheters in place or structural abnormalities of the urinary tract, Proteus mirabilis is also a frequent isolate. To study virulence of these bacterial species, we have isolated the genes that encode putative virulence factors, constructed specific mutations within these genes, introduced the mutation back into the wild type strain by allelic exchange, and analyzed these mutants for virulence in appropriate in vitro and in vivo models. Specific virulence markers have been identified for strains that cause urinary tract infection. For E. coli, these include P fimbriae, S fimbriae, hemolysin, aerobactin, serum resistance, and a small group of O-serotypes. Redundant virulence factors must be present in these organisms as mutation of the most clearly identified epidemiological marker, P fimbriae, does not result in attenuation of a virulent strain. For P. mirabilis, urease appears to contribute most significantly to virulence. Fimbriae play a significant but more subtle role in colonization. Hemolysin, although potently cytotoxic to renal cells in vitro, does not appear to contribute significantly to the pathogenesis of ascending urinary tract infection. We can conclude that the pathogenesis of urinary tract infection and acute pyelonephritis caused by uropathogenic E. coli and P. mirabilis are multifactorial, as mutation of single genes rarely causes significant attenuation of virulence.