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Effect of circumcision status on periurethral bacterial flora during the first year of life
T E Wiswell1, G M Miller, H M Gelston
1Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, Texas.
Insights
Uncircumcised infant boys have more periurethral bacteria and higher counts of uropathogenic organisms, increasing urinary tract infection risk. Circumcision may reduce bacterial colonization in the first six months of life.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Urology
Background:
- Urinary tract infections (UTIs) are common in infants.
- Bacterial colonization of the periurethral area is a suspected factor in UTI pathogenesis.
- The role of the foreskin in harboring bacteria and its association with UTIs requires further investigation.
Purpose of the Study:
- To investigate the association between the presence of a foreskin and periurethral bacterial colonization in male infants.
- To compare the types and quantities of bacteria, including uropathogens, in circumcised versus uncircumcised boys.
- To determine if bacterial colonization patterns correlate with UTI risk factors.
Main Methods:
- Longitudinal study comparing periurethral bacterial flora in circumcised and uncircumcised boys during the first year of life.
- Cultures (intraurethral and glans) obtained at multiple time points: 2 days, 2 weeks, 2, 4, 6, and 12 months.
- Analysis of bacterial types, total colony counts, and specific counts of uropathogenic organisms like Escherichia coli.
Main Results:
- Uncircumcised boys exhibited significantly higher total bacterial colony counts at most ages (p < 0.003).
- Escherichia coli and other Gram-negative uropathogens (Klebsiella-enterobacter, Proteus mirabilis, Pseudomonas aeruginosa) were found more frequently and in higher concentrations in uncircumcised boys during the first 6 months (p < 0.01).
- Glans and urethral cultures showed similar bacterial patterns.
Conclusions:
- The presence of a foreskin in male infants is associated with increased periurethral bacterial colonization, including potentially uropathogenic organisms, during the first six months of life.
- This increased bacterial load may contribute to a higher risk of urinary tract infections in uncircumcised infants.
- Findings suggest that the foreskin plays a role in harboring bacteria relevant to UTI pathogenesis.
Abstract:
To determine whether bacterial colonization is a factor in the pathogenesis of urinary tract infection, we compared the periurethral bacterial flora of uncircumcised versus circumcised boys during the first year of life. Intraurethral and circumferential glans cultures were obtained from 25 circumcised and 25 uncircumcised infants at 2 days, 2 weeks, 2 months, 4 months, 6 months, and 12 months of age. Different children were used at each age (300 total). The types of bacteria and the total and specific colony counts were compared. The results of the glans cultures were similar to those from the urethra. Uncircumcised boys had significantly higher total colony counts (p less than 0.003) at all ages except 12 months. Escherichia coli was present significantly more often (p less than 0.01) in the urethras of uncircumcised boys at 2 weeks, 2 months, 4 months, and 6 months. Gram-negative uropathogenic organisms (Klebsiella-enterobacter, Proteus mirabilis, and Pseudomonas aeruginosa) were cultured more frequently (p less than 0.0005) from the urethras of uncircumcised boys at 2 months, 4 months, and 6 months. The specific colony counts for E. coli and the other uropathogenic organisms were significantly higher (p less than 0.05) at all ages except 12 months. We conclude that during the first 6 months of life, the presence of a foreskin is associated with a greater quantity of periurethral bacteria and a greater likelihood for the presence of, as well as higher concentrations of, potentially uropathogenic organisms.