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Nat Commun. 2019 Sep 26;10(1):4379. doi: 10.1038/s41467-019-12359-3.

Possible role of L-form switching in recurrent urinary tract infection.

Author information

1
The Centre for Bacterial Cell Biology, The Institute for Cell and Molecular Biosciences, Medical School, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, UK. katarzyna.mickiewicz@ncl.ac.uk.
2
The Centre for Bacterial Cell Biology, The Institute for Cell and Molecular Biosciences, Medical School, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, UK.
3
Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
4
The Institute of Cellular Medicine, Newcastle University, 4th Floor, William Leech Building, Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
5
The Institute for Cell and Molecular Biosciences, Medical School, Newcastle University, Catherine Cookson Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
6
The Centre for Bacterial Cell Biology, The Institute for Cell and Molecular Biosciences, Medical School, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, UK. jeff.errington@ncl.ac.uk.

Abstract

Recurrent urinary tract infection (rUTI) is a major medical problem, especially in the elderly and infirm, but the nature of the reservoir of organisms responsible for survival and recolonisation after antibiotic treatment in humans is unclear. Here, we demonstrate the presence of cell-wall deficient (L-form) bacteria in fresh urine from 29 out of 30 older patients with rUTI. In urine, E. coli strains from patient samples readily transition from the walled state to L-form during challenge with a cell wall targeting antibiotic. Following antibiotic withdrawal, they then efficiently transition back to the walled state. E. coli switches between walled and L-form states in a zebrafish larva infection model. The results suggest that L-form switching is a physiologically relevant phenomenon that may contribute to the recurrence of infection in older patients with rUTI, and potentially other infections.

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