IMMUNOLOGICAL STUDIES ON URINARY TRACT INFECTIONS

II. THE HEMAGGLUTININ RESPONSE TO POSTOPERATIVE URINARY TRACT INFECTIONS

Abstract

Young's modified method being employed, hemagglutinin titers were determined to evaluate the antibody responses to O-antigens of dominant microorganisms isolated from urines in patients with urinary tract infections. Two hundred and thirty trials have been undertaken to cover to postoperative course of infections.
1) Hemagglutinin levels in preoperative non-infections cases demonstrate under 1/160, which are equivalent to those in normal subjects in author's previous study.
2) Microorganisms isolated from urines in 31 patients postoperatively are 67 strains, of which 41 strains (61%) show high hemagglutinin responses.
3) The specificity of organisms is noted in this antibody forming responses. Significant rise of titers in Enterobacteriaceae and Pseudomonas aeruginosa groups and low antibody responses in Alcaligenes and Staphylococcus groups are evident with one exception of high response in Staphylococcus epidermidis found in two cases, when it is combined with Enterobacteriaceae (E. coli and Kiebsiella) infection.
4) Hemagglutinin titers reach to the highest level within 3 weeks in most cases from the onset of infections (mean 3.3 weeks).
5) The rise and fall of this hemagglutinin response can be classified into 3 types.
I. Rapid rise and fall: This type represents the group of patients whose infections are usually controlled by medication.
II. Rapid rise and long duration: This means the long standing infections due to the same organism despite the multiple choices of chemotherapy.
III. Initial high level and gradual fall: This type indicates the eradication of infection which has been persisted in preoperative period.
These 3 types of hemagglutinin responses relatively manifest the courses of urinary tract infections.
6) Positive reaction (above 1/160) is obtained in 41 out of 59 patients whose urines contain more than 10⁵ organisms per ml, and there are obvious correlations between the degree of bacteriuria and significant rising of antibodies (above 1/640).
7) Antibody rises to Enterobacteriaceae, particularly to E. coli, are found 80-100 per cent in patients with fever above 38°C. There is no remarkable difference noted among strains of Enterobacteriaceae in the incidence of significant elevation of titers (above 1/640).
These results are discussed in relations to the similar biological activities of endotoxins in gram-negative bacteria.
8) No correlations is found between antibiotics sensitivities and hemagglutinin levels.
9) Continuous irrigation with 0.5% acetic acid solution through the indwelling catheter after prostatectomy induces good preventing effect to the postoperative infections. It is generally acceptable to keep urine acid in expecting bacteriostatic effect to the infecting organisms as to get low antibody response resulting the early eradication of infection.
10) Antibody response is concluded to demonstrate the specificity of infecting organisms and the process of infection. The rise and fall of this hemagglutinin titers to the microorganisms indicate the pathogenicities of these isolates in the urinary tract infections.