Journal
FEMS MICROBIOLOGY REVIEWS
Volume 36, Issue 3, Pages 616-648Publisher
OXFORD UNIV PRESS
DOI: 10.1111/j.1574-6976.2012.00339.x
Keywords
cystitis; urinary tract infection; UPEC; type 1 pili; intracellular bacterial communities; antibiotic resistance
Categories
Funding
- National Institutes of Health
- Office of Research on Women's Health Specialized Center of Research [DK64540, DK51406, AI48689, AI29549, AI49950, AI95542, K08 AI083746]
- Australian National Health and Medical Research Council [631654, APP1012076, APP1005315, APP1033799]
- Australian Research Council [FT100100662]
- University of Queensland
- Australian Research Council [FT100100662] Funding Source: Australian Research Council
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Bladder infections affect millions of people yearly, and recurrent symptomatic infections (cystitis) are very common. The rapid increase in infections caused by multidrug-resistant uropathogens threatens to make recurrent cystitis an increasingly troubling public health concern. Uropathogenic Escherichia coli (UPEC) cause the vast majority of bladder infections. Upon entry into the lower urinary tract, UPEC face obstacles to colonization that constitute population bottlenecks, reducing diversity, and selecting for fit clones. A critical mucosal barrier to bladder infection is the epithelium (urothelium). UPEC bypass this barrier when they invade urothelial cells and form intracellular bacterial communities (IBCs), a process which requires type 1 pili. IBCs are transient in nature, occurring primarily during acute infection. Chronic bladder infection is common and can be either latent, in the form of the quiescent intracellular reservoir (QIR), or active, in the form of asymptomatic bacteriuria (ASB/ABU) or chronic cystitis. In mice, the fate of bladder infection, QIR, ASB, or chronic cystitis, is determined within the first 24 similar to h of infection and constitutes a putative hostpathogen mucosal checkpoint that contributes to susceptibility to recurrent cystitis. Knowledge of these checkpoints and bottlenecks is critical for our understanding of bladder infection and efforts to devise novel therapeutic strategies.
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