Clonal diversity of Escherichia coli colonizing stools and urinary tracts of young girls

Intestinal carriage of Escherichia coli in prepubertal girls without a history of urinary tract infection was examined by collecting weekly stools and periurethral and urine samples over 3 to 4 weeks of study. Dominant and minor clones were defined by grouping 28 E. coli isolates into clonal types. Multiple enteric clones of E. coli, which changed week to week, were found in the 13 girls during the study (median, 3 clones/girl; range, 1 to 16 clones/girl). Dominance of an enteric clone did not predict persistence in the stool. In only 10 (34%) of the 29 episodes in which a dominant clone present in one weekly sample could have been detected the following week did it persist as the dominant clone in the next weekly sample. In 5 (17%) of the 29 episodes, a dominant clone found in one weekly sample was classified as a minor clone the next week. Both dominant and minor clones were observed to colonize the urinary tract. However, when colonization of the periurethra or bladder urine occurred, it was brief and often did not reflect the dominant stool flora from the same week. In fact, in only 40% of episodes was a clone that was detected either on the periurethra or in the urine also recovered from the stool the same week. Our findings suggest that the intestinal flora of healthy girls is multiclonal with frequent fluctuations in composition.