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Risk Factors in Upper Urinary Tract Infection Caused by E. Coli

Old age and papG class II allele in patients with upper urinary tract infection (UTI) are risk factors for the development of Escherichia coli (E. coli) bacteremia.

A retrospective study done by researchers at the National Cheng Kung University in Tainan, Taiwan, looked at 139 adults with upper or lower UTI caused by E. coli between January 1997 and December 1999. It showed that, for those with predisposing factors, less virulent strains could cause upper UTI.

They compared 81 upper UTI subjects with 58 lower UTI subjects to identify host and E. coli virulence factors, and the association between major predisposing host factors for upper UTI and urovirulence genes for E. coli. Host factors more frequently associated with upper UTI than with lower UTI were older age (60 years), male sex, diabetes with poor blood glucose control, immunosuppression, and urinary tract obstruction.

The papG class II allele was detected more frequently for E. coli strains isolated from upper UTI subjects than from those with lower UTI (85 percent versus 52 percent; P < 0.0001).

Using multivariate analysis, the researchers found that along with papG class II allele diabetes with poor blood glucose control, immunosuppression, and urinary tract obstruction were independently associated with upper UTI. Where these three predisposing host factors were not present, the prevalence of papG class II allele was significantly greater in patients with upper UTI than those with lower UTI.

It was less prevalent, however, in strains isolated from upper UTI patients with urinary tract obstruction or with two of the other host factors.
American Journal of Kidney Diseases, 2002, Vol 39, No 4. "Roles of host and bacterial virulence factors in the development of upper urinary tract infection caused by Escherichia coli"

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