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Urinary tract infections (UTIs) are one of the most common bacterial infections and are predominantly caused by uropathogenic Escherichia coli (UPEC). While UTIs are typically considered extracellular infections, it has been recently demonstrated that UPEC bind to, invade, and replicate within the murine bladder urothelium to form intracellular bacterial communities (IBCs). These IBCs dissociate and bacteria flux out of bladder facet cells, some with filamentous morphology, and ultimately establish quiescent intracellular reservoirs that can seed recurrent infection. This IBC pathogenic cycle has not yet been investigated in humans. In this study we sought to determine whether evidence of an IBC pathway could be found in urine specimens from women with acute UTI.

In this issue of PLoS Medicine, Rosen and colleagues present convincing evidence that intracellular communities of Escherichia coli commonly exist and are likely of to be of clinical significance in uncomplicated bacterial cystitis. This novel finding is remarkable in many respects, not the least of which is the circuitous route by which our understanding about bacterial communities has evolved in the pathogenesis of infectious diseases.

A study published this week in the open access journal PLoS Medicine presents convincing evidence that intracellular bacterial communities (IBCs) commonly exist in women with bladder infections and may contribute to the recurrence of these infections. In mice it has already been established that Escherichia coli (E coli), a type of bacterium that causes urinary tract infections, can avoid the immune system by invading cells lining the bladder, replicate and ultimately re-infect the urinary tract. The existence of IBCs in this new study suggests that a similar cycle may occur in people and that perhaps longer treatment with antibiotics that kill bacteria inside human cells may be necessary for some patients.