Bacterial adherence and other virulence factors for urinary tract infection
- Alain Meyrier, MD
Alain Meyrier, MD
- Professor of Medicine (Emeritus)
- Université Paris-Descartes, Paris, France
Bacterial adhesion onto mucosal or urothelial cells is an important phenomenon determining bacterial virulence. Infection in the urinary tract is related in part to the ability of bacteria to adhere and colonize the gut, perineum, urethra, bladder, renal pelvicalyceal system, and renal interstitium [1-6]. Adhesion is particularly important when infection occurs in an anatomically normal urinary tract [3,5,6], but it is also important in recurrent cystitis and infection complicating indwelling bladder catheters [7,8].
The pathophysiology of bacterial adhesion in the urinary tract is complex. Uropathogenic Enterobacteriaceae are electronegative and too small to overcome repulsion by the net negative charge of epithelial cells. As a result, bacterial adhesion cannot occur in the absence of fimbriae or other (nonfimbrial) surface adhesion systems. These systems have favorable electrical charge and also promote adhesion via hydrophobicity. Fimbriae allow irreversible attachment to the uroepithelial cell membrane via adhesins [5,6].
This topic review will primarily consider the role of bacterial adhesion as a virulence determinant of Escherichia coli and Proteus mirabilis, the two most common strains responsible for urinary tract infection (UTI). Virulence factors of E. coli are mainly responsible for promoting progression of the organism from the fecal reservoir into the bladder and occasionally the kidney. In comparison, virulence factors of P. mirabilis can induce UTI but are particularly important for the formation of infectious struvite stones.
Bacterial virulence is not related to resistance to antimicrobial drugs. As an example, the most adherent strain of E. coli in the patient's intestinal flora is usually sensitive to most antibiotics.
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