Periurethral anaerobic microflora of healthy girls

Journal of Clinical Microbiology (Impact Factor: 3.99). 11/1979; 10(4):419-24.
Source: PubMed


The periurethral anaerobic and aerobic microfloras were investigated in 18 healthy premenarcheal girls, 5 to 14 years of age, by using a quantitative sampling method. Colonization of the female periurethral area with enterobacteria seems to be an important step in the development of urinary tract infections, and the present study was undertaken as a stage in elucidating factors that might control the establishment of urinary tract pathogens periurethrally. The study showed that obligate anaerobic bacteria constituted 95.0% (standard error, +/- 5.8%) of the total colony-forming units per square centimeter of periurethral area. An average of 7.0 different anaerobic and 2.7 different aerobic strains per specimen was obtained. The flora was dominated by anaerobic gram-positive cocci and gram-positive rods, whereas anaerobic gram-negative rods comprised a minor part. The most commonly encountered anaerobic isolates were peptococci and peptostreptococci, propionibacteria, bifidobacteria, eubacteria, and bacteroides in decreasing order of frequency. The aerobic flora consisted most commonly of nonhemolytic streptococci and diphtheroids. The findings suggest that the periurethral microenvironment is a distinctive ecological niche, separate from the fecal and skin biotas, although it has some characteristics in common with the vaginal flora.

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    ABSTRACT: We characterized theaerobic andanaerobic urethral flora ofhealthy females inthree physiological agegroups (premenarcheal, reproductive, andpostmeno- pausal) andoffemales withurinary tract infections. Themeannumberofspecies persample was6.5, 7.7, and10.3foreachofthephysiological agegroups, respectively, and6.5fortheurinary tract infection group. Markedquantitative changes wereseenwithageanddisease. Aerobes accounted for65.6 and73.8% of theflora ofthepremenarcheal andreproductive agegroups, respectively, whereas anaerobes weredominant inthepostmenopausal agegroup, accounting for65.5% oftheflora. Aerobic gram-negative rodswerenotisolated fromanyofthe premenarcheal orreproductive-age subjects. Ofthe10postmenopausal subjects, 5carried aerobic gram-negative rods, butthese organisms accounted foronly1% oftheflora. Incontrast, theyconstituted 95%oftheurethral flora oftheurinary tract infection group. Bacteroides melaninogenicus wascommonly isolated and wasthedominant isolate inthepostmenopausal agegroup. Bacteroides fragilis wasrecovered from7ofthe10postmenopausal subjects, butthese organisms constituted only3%ofthetotal flora. Thefactors responsible forthechanges in urethral flora withageremain tobedetermined. Inaprevious study (15), weshowedthatthe aerobic andanaerobic urethral flora couldbe delineated byculturing thefirst 10mlofvoided urine (urethral urine). Inthatstudy, results ob- tained withurethral urine cultures correlated well withthose obtained withurethral swabs. Wefound that theurethral flora inreproductive- agefemales consisted ofbothaerobes andan- aerobes. Sucharichendogenous urethral flora raises thequestion ofitsrole asahostdefense mechanism. Various pieces ofevidence suggest thatnormal flora isimportant inthisregard. Previous investigators (17) haveshownthat vir- idans groupstreptococci will inhibit thegrowth ofgroup Abeta-hemolytic streptococci. Murray andRosenblatt haveshownthatBacteroides melaninogenicus invitro will inhibit thegrowth ofseveral strains ofaerobic gram-negative rods (16). Theincidence ofasymptomatic bacteriuria increases withage(21), asdoestheincidence of colonization oftheoropharynx byaerobic gram- negative rods(20), suggesting thatchanges in normalflora aredynamic andinfluenced by several variables. Ifwearetoelucidate therole oftheurethral flora asahostdefense mechanism, itisimpor- tanttoknowhowthenormal aerobic andanaer- obicflora change withphysiological age. Inthis study, wehavecharacterized theaerobic and anaerobic urethral flora ofhealthy females in three physiological agegroups (premenarcheal, reproductive, andpostmenopausal) andcom- pareditqualitatively andquantitatively with theflora ofsixreproductive-age females with urinary tract infections.
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    ABSTRACT: One of the primary goals of management of patients with neurogenic bladder (NB) dysfunction is the prevention of recurrent urinary tract infections (UTI). Inspite of much research in the field, there continue to be gaps in our understanding as to why these patients are vulnerable to recurrent UTIs. UTI rates in the NB population continue to be high and in the absence of clear guidelines on the subject, it is the clinician’s beliefs rather than robust evidence which dictates current prophylactic therapies for UTI prevention. This article reviews the pathophysiology behind recurrent UTI in NB population, the rationale and evidence of traditional preventive therapies, and an update on the upcoming approaches to tackle this difficult problem. Ultimately, an individualized approach, in which the clinician first attempts to identify the contribution of various factors predisposing to UTI in a particular patient, e.g., compromised host defences, impaired washout, catheterization related etc., and then aims to optimize each of those factors is the need of the hour.
    No preview · Article · Sep 2013 · Current Bladder Dysfunction Reports

  • No preview · Article · Feb 1980 · The Lancet
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