Effect of trimethoprim-sulfamethoxazole on recurrent bacteriuria and bacterial persistence in mice infected with uropathogenic Escherichia coli

Infect Immun. 2002 Dec;70(12):7042-9. doi: 10.1128/IAI.70.12.7042-7049.2002.


One of the more perplexing aspects of urinary tract infections (UTIs) is their high propensity to recur. It has been proposed that recurrent infections are a result of the reintroduction of bacteria from the gastrointestinal tract (GIT) to the urinary tract (UT); however, since a significant subset of recurrent UTIs are caused by an identical bacterial strain, it has been challenging to formally prove this hypothesis for same-strain recurrences by using epidemiologic approaches. We present data here obtained by using a mouse model of UTIs in which it was shown that 36% (5 of 14) of mice infected with uropathogenic Escherichia coli (UPEC) will have at least one bacteriuric recurrence, with 21% (3 of 14) having more than one recurrence during a 6-week period after an acute UTI. Intraurethrally infected mice develop UPEC reservoirs in both their feces and their bladders. Ten days of trimethoprim-sulfamethoxazole (SXT) therapy reduces urinary recurrences and eradicates fecal colonization, whereas 3 days of SXT treatment has no effect over a twenty-eight-day observation period despite clearing fecal colonization acutely. Interestingly, SXT is unable to eradicate bacteria from the bladder reservoir even after a 10-day treatment regimen, thus demonstrating that the bladder reservoir can persist even in the face of long-term antibiotic therapy.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Animals
  • Anti-Infective Agents, Urinary / administration & dosage
  • Anti-Infective Agents, Urinary / therapeutic use*
  • Bacteriuria / drug therapy
  • Bacteriuria / microbiology
  • Bacteriuria / prevention & control*
  • Disease Models, Animal
  • Escherichia coli / drug effects*
  • Escherichia coli / growth & development*
  • Escherichia coli Infections / drug therapy
  • Escherichia coli Infections / microbiology
  • Feces / microbiology
  • Female
  • Mice
  • Mice, Inbred C57BL
  • Recurrence
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination / administration & dosage
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use*
  • Urinary Bladder / microbiology
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / microbiology


  • Anti-Infective Agents, Urinary
  • Trimethoprim, Sulfamethoxazole Drug Combination