RECURRENCE OF URINARY-TRACT INFECTION IN A PRIMARY-CARE SETTING - ANALYSIS OF A 1-YEAR FOLLOW-UP OF 179 WOMEN

In a prospective study, 179 adult women (age range, 17-82 years) were followed up for 12 months after an index episode of community-acquired cystitis caused by Escherichia coli, Episodes of symptomatic urinary tract infection (UTI) were recorded, and urinary isolates were compare d with the index episode isolate; 147 UTI episodes were detected durin g the follow-up. Of these episodes, 131 were classified as recurrences occurring at least 1 month after the index episode; 44% of the patien ts had recurrences, A history of UTI increased the risk of recurrence; only 11.8% of the 17 patients without previous episodes of UTI had at least one recurrence, while 47.5% of those with previous episodes had at least one recurrence (OR, 6.8; univariate logistic regression), E. coli caused 78% of the recurrent episodes. Phenotypic and genotypic a nalysis of E. coli strains showed that one-third of the recurrences we re caused by the index episode strain, which could persist and cause r ecurrences throughout the 1-year follow-up period, The prevalence of a dhesins or other identified virulence factors for UTI among the recurr ence strains was identical to that among the index episode strains, Th e presence of these factors did not affect the risk of recurrence but did increase the likelihood that the index episode strain would persis t and cause recurrent episodes of UTI.